Provider Demographics
NPI:1477281285
Name:WINKLER, KIM F (COTA)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:F
Last Name:WINKLER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 JANET CT
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:54180-1156
Mailing Address - Country:US
Mailing Address - Phone:920-309-0765
Mailing Address - Fax:
Practice Address - Street 1:MANITOWOC COUNTY BIRTH TO #
Practice Address - Street 2:4319 EXPO DRIVE
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54229
Practice Address - Country:US
Practice Address - Phone:920-885-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1721-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant