Provider Demographics
NPI:1639483480
Name:WELP, KEVIN WILLIAM (COTA)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:WILLIAM
Last Name:WELP
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11345 INTERLACHEN RD
Mailing Address - Street 2:
Mailing Address - City:CHISAGO CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55013-9552
Mailing Address - Country:US
Mailing Address - Phone:612-398-4173
Mailing Address - Fax:
Practice Address - Street 1:11345 INTERLACHEN RD
Practice Address - Street 2:
Practice Address - City:CHISAGO CITY
Practice Address - State:MN
Practice Address - Zip Code:55013-9552
Practice Address - Country:US
Practice Address - Phone:612-398-4173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211066224Z00000X
MN201619224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant