Provider Demographics
NPI:1629565296
Name:LUER, KYLIE MARIE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KYLIE
Middle Name:MARIE
Last Name:LUER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:WILD ROSE
Mailing Address - State:WI
Mailing Address - Zip Code:54984-6804
Mailing Address - Country:US
Mailing Address - Phone:920-622-4342
Mailing Address - Fax:
Practice Address - Street 1:425 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:WILD ROSE
Practice Address - State:WI
Practice Address - Zip Code:54984-6804
Practice Address - Country:US
Practice Address - Phone:920-622-4342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6285225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist