Healthcare Provider Details

I. General information

NPI: 1275966202
Provider Name (Legal Business Name): KATHLEEN ANNE MICHOR OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MEADOWLARK DR
MADISON WI
53714-2629
US

IV. Provider business mailing address

545 W DAYTON ST
MADISON WI
53703-1995
US

V. Phone/Fax

Practice location:
  • Phone: 608-204-3420
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: