Healthcare Provider Details

I. General information

NPI: 1457264608
Provider Name (Legal Business Name): KALLI CLAIR
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 N 76TH ST
MILWAUKEE WI
53223-1074
US

IV. Provider business mailing address

4240 S RAVINIA DR 6-111
GREENFIELD WI
53221-5738
US

V. Phone/Fax

Practice location:
  • Phone: 414-355-9300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number9107-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: