Provider Demographics
NPI:1629213020
Name:KAISER, MARLENE K (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:K
Last Name:KAISER
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:N50W17046 MAPLE CREST LN
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-6692
Mailing Address - Country:US
Mailing Address - Phone:262-783-6759
Mailing Address - Fax:262-783-6747
Practice Address - Street 1:N50W17046 MAPLE CREST LN
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-6692
Practice Address - Country:US
Practice Address - Phone:262-783-6759
Practice Address - Fax:262-783-6747
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-14
Last Update Date:2008-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI663-019171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor