Provider Demographics
NPI:1295819431
Name:BLEEKE, KRISTINA MARIE (OTR)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:MARIE
Last Name:BLEEKE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:KRISTINA
Other - Middle Name:MARIE
Other - Last Name:RUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:6715 W ENGLISH MEADOWS DR
Mailing Address - Street 2:APARTMENT B305
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-3991
Mailing Address - Country:US
Mailing Address - Phone:414-282-4929
Mailing Address - Fax:
Practice Address - Street 1:5071 S LAKE DR
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-2033
Practice Address - Country:US
Practice Address - Phone:414-744-7630
Practice Address - Fax:414-744-7655
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3183225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist