Provider Demographics
NPI:1285014068
Name:SIDERIS, KATHY (OTR)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:SIDERIS
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 1:4500 W LOOMIS RD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4819
Mailing Address - Country:US
Mailing Address - Phone:414-325-5375
Mailing Address - Fax:414-325-5475
Practice Address - Street 1:4500 W LOOMIS RD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4819
Practice Address - Country:US
Practice Address - Phone:414-325-5375
Practice Address - Fax:414-325-5475
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4214-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist