Healthcare Provider Details

I. General information

NPI: 1891600540
Provider Name (Legal Business Name): KATHERINE MENNENGA OTR, OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 E PINE ST
LAKE MILLS WI
53551-1103
US

IV. Provider business mailing address

3007 PHEASANT RUN
COTTAGE GROVE WI
53527-9751
US

V. Phone/Fax

Practice location:
  • Phone: 920-648-2338
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number275926
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: