Healthcare Provider Details

I. General information

NPI: 1285526863
Provider Name (Legal Business Name): STELLAR KINETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3019 W SPENCER ST STE 104
APPLETON WI
54914-5946
US

IV. Provider business mailing address

3019 W SPENCER ST STE 104
APPLETON WI
54914-5946
US

V. Phone/Fax

Practice location:
  • Phone: 520-609-4324
  • Fax:
Mailing address:
  • Phone: 520-609-4324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE KSIONDA
Title or Position: CEO
Credential: OTR/L
Phone: 520-609-4324