Healthcare Provider Details

I. General information

NPI: 1386309086
Provider Name (Legal Business Name): MICHELLE KASTENHOLZ OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE MURPHY OTR

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7420 DEVONSHIRE DR
CEDARBURG WI
53012-8814
US

IV. Provider business mailing address

7420 DEVONSHIRE DR
CEDARBURG WI
53012-8814
US

V. Phone/Fax

Practice location:
  • Phone: 612-747-0119
  • Fax:
Mailing address:
  • Phone: 612-747-0119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3086
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: