Provider Demographics
NPI:1700198124
Name:WAUWATOSA THERAPIES LLC
Entity Type:Organization
Organization Name:WAUWATOSA THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KEBBEKUS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR
Authorized Official - Phone:414-763-6996
Mailing Address - Street 1:2473 NORTH 60TH STREET
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2222
Mailing Address - Country:US
Mailing Address - Phone:414-763-6996
Mailing Address - Fax:414-221-0057
Practice Address - Street 1:515 NORTH GLENVIEW AVENUE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-3234
Practice Address - Country:US
Practice Address - Phone:414-763-6996
Practice Address - Fax:414-221-0057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4408-26225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty