Provider Demographics
NPI:1659601201
Name:BADER, KARA SUE
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:SUE
Last Name:BADER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:981 STRATFORD CT
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-7003
Mailing Address - Country:US
Mailing Address - Phone:815-291-0005
Mailing Address - Fax:
Practice Address - Street 1:981 STRATFORD CT
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-7003
Practice Address - Country:US
Practice Address - Phone:815-291-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist