Provider Demographics
NPI:1740305481
Name:KAISER, LAVERNE MARGARET
Entity type:Individual
Prefix:MRS
First Name:LAVERNE
Middle Name:MARGARET
Last Name:KAISER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LAVERNE
Other - Middle Name:MARGARET
Other - Last Name:WISNIEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:3762 S 97TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53228-1421
Mailing Address - Country:US
Mailing Address - Phone:414-541-3015
Mailing Address - Fax:
Practice Address - Street 1:5790 S 27TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-4129
Practice Address - Country:US
Practice Address - Phone:414-817-3720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2012-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1169-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist