Healthcare Provider Details

I. General information

NPI: 1932652732
Provider Name (Legal Business Name): KAREN NEUSEN BS, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13111 N PORT WASHINGTON RD
MEQUON WI
53097-2416
US

IV. Provider business mailing address

13111 N PORT WASHINGTON RD
MEQUON WI
53097-2416
US

V. Phone/Fax

Practice location:
  • Phone: 262-243-7388
  • Fax:
Mailing address:
  • Phone: 262-243-7388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3040-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: