Provider Demographics
NPI:1740430453
Name:WILKOWSKI, KATHLEEN SUZANNE (OT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:SUZANNE
Last Name:WILKOWSKI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N3132 FIANN ST
Mailing Address - Street 2:
Mailing Address - City:MARKESAN
Mailing Address - State:WI
Mailing Address - Zip Code:53946-7952
Mailing Address - Country:US
Mailing Address - Phone:920-394-2500
Mailing Address - Fax:
Practice Address - Street 1:N3132 FIANN ST
Practice Address - Street 2:
Practice Address - City:MARKESAN
Practice Address - State:WI
Practice Address - Zip Code:53946-7952
Practice Address - Country:US
Practice Address - Phone:920-394-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4184-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist