Healthcare Provider Details

I. General information

NPI: 1871061069
Provider Name (Legal Business Name): KATHLEEN ELIZABETH WHITE C.P.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6790 W. LAYTON AVE
GREENFIELD WI
53220
US

IV. Provider business mailing address

326 W. FLORIDA ST. APT #206
MILWAUKEE WI
53204
US

V. Phone/Fax

Practice location:
  • Phone: 414-282-3100
  • Fax: 414-282-3101
Mailing address:
  • Phone: 847-347-1605
  • Fax: 414-282-3101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: