Provider Demographics
NPI:1275780868
Name:KAAS-LALLENSACK, STELLA D (OTR)
Entity Type:Individual
Prefix:MRS
First Name:STELLA
Middle Name:D
Last Name:KAAS-LALLENSACK
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:W5774 GARTON RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:WI
Mailing Address - Zip Code:53073-2849
Mailing Address - Country:US
Mailing Address - Phone:920-876-2521
Mailing Address - Fax:920-849-1811
Practice Address - Street 1:W5774 GARTON RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073
Practice Address - Country:US
Practice Address - Phone:920-876-2521
Practice Address - Fax:920-849-1811
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI815-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40676400Medicaid