Healthcare Provider Details

I. General information

NPI: 1356936892
Provider Name (Legal Business Name): KATHERINE LUCIA GAULKE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHERINE LUCIA LASOCKI OTR/L

II. Dates (important events)

Enumeration Date: 03/06/2021
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 E CALUMET ST
CHILTON WI
53014-1649
US

IV. Provider business mailing address

W6017 ELLA LN
PLYMOUTH WI
53073-4067
US

V. Phone/Fax

Practice location:
  • Phone: 920-204-7093
  • Fax:
Mailing address:
  • Phone: 920-251-9382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3136
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: