Provider Demographics
NPI:1932357860
Name:BERAN, KATHRYN ANN (OTR)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:BERAN
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 1:750 E LOUISIANA ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CROIX FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54024-9501
Mailing Address - Country:US
Mailing Address - Phone:715-483-2713
Mailing Address - Fax:715-483-5113
Practice Address - Street 1:750 E LOUISIANA ST
Practice Address - Street 2:
Practice Address - City:SAINT CROIX FALLS
Practice Address - State:WI
Practice Address - Zip Code:54024-9501
Practice Address - Country:US
Practice Address - Phone:715-483-2713
Practice Address - Fax:715-483-5113
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2709-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40794500Medicaid