Healthcare Provider Details

I. General information

NPI: 1063349579
Provider Name (Legal Business Name): KRISTEN HEBBARD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 SCHEURING RD
DE PERE WI
54115-1701
US

IV. Provider business mailing address

6624 DEUSTER ROAD
GREENLEAF WI
54126
US

V. Phone/Fax

Practice location:
  • Phone: 920-336-5754
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6023-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: