Healthcare Provider Details

I. General information

NPI: 1891098844
Provider Name (Legal Business Name): KATHERINE EMMA OBRIEN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE EMMA SCHAUMBURG

II. Dates (important events)

Enumeration Date: 12/14/2010
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N27W5707 LINCOLN BLVD
CEDARBURG WI
53012-2852
US

IV. Provider business mailing address

N27W5707 LINCOLN BLVD
CEDARBURG WI
53012-2852
US

V. Phone/Fax

Practice location:
  • Phone: 262-376-7676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.008885
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: