Healthcare Provider Details

I. General information

NPI: 1265724116
Provider Name (Legal Business Name): MONICA THERESE KUTZ OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 3RD ST W SUITE 135
ASHLAND WI
54806-1553
US

IV. Provider business mailing address

N10504 GRANDVIEW LN
IRONWOOD MI
49938-9621
US

V. Phone/Fax

Practice location:
  • Phone: 715-682-0633
  • Fax: 715-682-0736
Mailing address:
  • Phone: 906-932-5990
  • Fax: 906-932-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5034-26
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201007977
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: