Provider Demographics
NPI:1013121516
Name:WYSOCKI, KAREN L
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:L
Last Name:WYSOCKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2753 COUNTY ROAD I
Mailing Address - Street 2:
Mailing Address - City:SAUKVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53080-1539
Mailing Address - Country:US
Mailing Address - Phone:262-268-3890
Mailing Address - Fax:
Practice Address - Street 1:2753 COUNTY ROAD I
Practice Address - Street 2:
Practice Address - City:SAUKVILLE
Practice Address - State:WI
Practice Address - Zip Code:53080-1539
Practice Address - Country:US
Practice Address - Phone:262-268-3890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4664-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41041000Medicaid