Provider Demographics
NPI:1235190588
Name:CONZEMIUS, KAY (OTR)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:
Last Name:CONZEMIUS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 32ND ST S
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-7026
Mailing Address - Country:US
Mailing Address - Phone:608-788-7118
Mailing Address - Fax:608-787-6171
Practice Address - Street 1:2045 32ND ST S
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-7026
Practice Address - Country:US
Practice Address - Phone:608-788-7118
Practice Address - Fax:608-787-6171
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1261-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN45F72BAOtherBC/BS MN#
WI40672600Medicaid
WI40672600Medicaid