Provider Demographics
NPI:1871638015
Name:KLUMPP, DAVID T (OT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:T
Last Name:KLUMPP
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5913 N KENT AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4615
Mailing Address - Country:US
Mailing Address - Phone:414-967-8864
Mailing Address - Fax:
Practice Address - Street 1:4448 W LOOMIS RD
Practice Address - Street 2:#205
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4800
Practice Address - Country:US
Practice Address - Phone:414-281-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3650225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40902700Medicaid
WI40902700Medicaid