Healthcare Provider Details

I. General information

NPI: 1871797779
Provider Name (Legal Business Name): KATHLEEN O'KEEFE JOHNSON OTA L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN ANN O'KEEFE

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 ENLOE ST
HUDSON WI
54016-8173
US

IV. Provider business mailing address

2225 GREENWOOD VALLEY DR
RIVER FALLS WI
54022
US

V. Phone/Fax

Practice location:
  • Phone: 715-386-2128
  • Fax: 715-386-6119
Mailing address:
  • Phone: 715-425-1595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2041
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: