Provider Demographics
NPI:1437277738
Name:KRAEMER, MARGARET R (PTA)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:R
Last Name:KRAEMER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W2695 DUCK CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:NESHKORO
Mailing Address - State:WI
Mailing Address - Zip Code:54960-8137
Mailing Address - Country:US
Mailing Address - Phone:920-570-1891
Mailing Address - Fax:
Practice Address - Street 1:251 FOREST LN
Practice Address - Street 2:
Practice Address - City:MONTELLO
Practice Address - State:WI
Practice Address - Zip Code:53949-9380
Practice Address - Country:US
Practice Address - Phone:608-297-2153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI830-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40056100Medicaid