Provider Demographics
NPI:1396189700
Name:PUNTILLO, KACY (OTD, MS, OTR)
Entity Type:Individual
Prefix:
First Name:KACY
Middle Name:
Last Name:PUNTILLO
Suffix:
Gender:F
Credentials:OTD, MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8715 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-4713
Mailing Address - Country:US
Mailing Address - Phone:262-496-0289
Mailing Address - Fax:
Practice Address - Street 1:8715 2ND AVE
Practice Address - Street 2:
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-4713
Practice Address - Country:US
Practice Address - Phone:262-496-0289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5729-26225XP0200X
CO0003513225XP0200X
IL056.010239225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics