Healthcare Provider Details

I. General information

NPI: 1841761707
Provider Name (Legal Business Name): KELSEY DYKEMA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 W DEAN RD
MILWAUKEE WI
53223-2637
US

IV. Provider business mailing address

3351 PRIMROSE LN
YPSILANTI MI
48197-3216
US

V. Phone/Fax

Practice location:
  • Phone: 414-371-7300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: