Healthcare Provider Details

I. General information

NPI: 1508646555
Provider Name (Legal Business Name): KYLIE SCHELL MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KYLIE RICHTER MS, OTR/L

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 7TH AVE
ANTIGO WI
54409-1810
US

IV. Provider business mailing address

815 7TH AVE
ANTIGO WI
54409-1810
US

V. Phone/Fax

Practice location:
  • Phone: 715-627-4355
  • Fax:
Mailing address:
  • Phone: 715-651-9285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8802-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: