Healthcare Provider Details

I. General information

NPI: 1093644510
Provider Name (Legal Business Name): KRISTEN PAXSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 W MILL RD
GLENDALE WI
53209-3212
US

IV. Provider business mailing address

3862 S LAKE DR UNIT 410
SAINT FRANCIS WI
53235-5231
US

V. Phone/Fax

Practice location:
  • Phone: 414-351-7160
  • Fax:
Mailing address:
  • Phone: 484-330-1302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6620-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: