Provider Demographics
NPI:1760645162
Name:DAKTER, KATHLEEN (CMT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:DAKTER
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 9TH DR
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN DELLS
Mailing Address - State:WI
Mailing Address - Zip Code:53965-8500
Mailing Address - Country:US
Mailing Address - Phone:608-254-6022
Mailing Address - Fax:608-254-2611
Practice Address - Street 1:3720 9TH DR
Practice Address - Street 2:
Practice Address - City:WISCONSIN DELLS
Practice Address - State:WI
Practice Address - Zip Code:53965-8500
Practice Address - Country:US
Practice Address - Phone:608-254-6022
Practice Address - Fax:608-254-2611
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2359-046225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist