Provider Demographics
NPI:1346497369
Name:KRIZEK, KATHERINE ANN (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:ANN
Last Name:KRIZEK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:ANN
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2035 RAINTREE LN
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-7650
Mailing Address - Country:US
Mailing Address - Phone:262-456-4855
Mailing Address - Fax:
Practice Address - Street 1:8633 32ND AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-5187
Practice Address - Country:US
Practice Address - Phone:414-694-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4658-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist