Provider Demographics
NPI:1265724116
Name:KUTZ, MONICA THERESE (OTR)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:THERESE
Last Name:KUTZ
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:N10504 GRANDVIEW LN
Mailing Address - Street 2:
Mailing Address - City:IRONWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49938-9621
Mailing Address - Country:US
Mailing Address - Phone:906-932-5990
Mailing Address - Fax:906-932-4153
Practice Address - Street 1:422 3RD ST W
Practice Address - Street 2:SUITE 135
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1553
Practice Address - Country:US
Practice Address - Phone:715-682-0633
Practice Address - Fax:715-682-0736
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5034-26225X00000X
MI5201007977225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist