Provider Demographics
NPI:1336478437
Name:KUEPPER, LEAH MARIE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:MARIE
Last Name:KUEPPER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:LEAH
Other - Middle Name:MARIE
Other - Last Name:KUEPPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:3821 KOHLER MEMORIAL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3600
Mailing Address - Country:US
Mailing Address - Phone:920-208-9648
Mailing Address - Fax:920-208-6316
Practice Address - Street 1:3821 KOHLER MEMORIAL DR STE 102
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3600
Practice Address - Country:US
Practice Address - Phone:920-208-9648
Practice Address - Fax:920-208-6316
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1315-19225200000X
WI5491-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant