Provider Demographics
NPI:1578174819
Name:SCHMIDT, KAITLYN (OTR)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:SASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:262-375-3700
Mailing Address - Fax:262-376-6032
Practice Address - Street 1:215 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-1700
Practice Address - Country:US
Practice Address - Phone:262-375-3700
Practice Address - Fax:262-376-6032
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6658-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI6658-26OtherWI STATE LICENSE
WI100102715Medicaid