Provider Demographics
NPI:1891968202
Name:KIRKISH-MAYER, ANNETTE T (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:T
Last Name:KIRKISH-MAYER
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 1:13485 W OLD OAK LN
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-2531
Mailing Address - Country:US
Mailing Address - Phone:262-797-8872
Mailing Address - Fax:
Practice Address - Street 1:13485 W OLD OAK LN
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-2531
Practice Address - Country:US
Practice Address - Phone:262-797-8872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1429-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40507200Medicaid