Healthcare Provider Details

I. General information

NPI: 1285043414
Provider Name (Legal Business Name): KIMBERLY GOETTL OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 CARMICHAEL RD
HUDSON WI
54016-8322
US

IV. Provider business mailing address

73 LOCKWOOD CT
HUDSON WI
54016-7743
US

V. Phone/Fax

Practice location:
  • Phone: 715-377-3703
  • Fax:
Mailing address:
  • Phone: 715-308-1494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number104727
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number6565-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: