Provider Demographics
NPI:1669545034
Name:LOHTARI-KUKLIN, MARJUT AINO (MA, OTR)
Entity type:Individual
Prefix:MS
First Name:MARJUT
Middle Name:AINO
Last Name:LOHTARI-KUKLIN
Suffix:
Gender:F
Credentials:MA, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 N HARCOURT PL
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2445
Mailing Address - Country:US
Mailing Address - Phone:414-332-2040
Mailing Address - Fax:414-332-7867
Practice Address - Street 1:1000 N 92ND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3533
Practice Address - Country:US
Practice Address - Phone:414-744-7630
Practice Address - Fax:414-744-7655
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI755-026174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40572700-35Medicaid