Healthcare Provider Details

I. General information

NPI: 1033119102
Provider Name (Legal Business Name): DAVID J KRATZER OT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 N MILWAUKEE ST 208
MILWAUKEE WI
53202-5885
US

IV. Provider business mailing address

1185 SANDPIPER DR
OCONOMOWOC WI
53066-2363
US

V. Phone/Fax

Practice location:
  • Phone: 414-615-0665
  • Fax: 414-615-0667
Mailing address:
  • Phone: 262-354-0515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4191-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: