Provider Demographics
NPI:1811209331
Name:DEMBY, KERRY JEAN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:JEAN
Last Name:DEMBY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5218 N LOVERS LANE RD
Mailing Address - Street 2:#4
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225
Mailing Address - Country:US
Mailing Address - Phone:262-501-9469
Mailing Address - Fax:
Practice Address - Street 1:5218 N LOVERS LANE RD
Practice Address - Street 2:4
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-3078
Practice Address - Country:US
Practice Address - Phone:262-501-9469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2013-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3209-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1811209331Medicaid