Healthcare Provider Details

I. General information

NPI: 1164805404
Provider Name (Legal Business Name): RACHEL KAUTZ OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11333 W NATIONAL AVE
MILWAUKEE WI
53227-3111
US

IV. Provider business mailing address

W237N549 OAKRIDGE DR
WAUKESHA WI
53188-1819
US

V. Phone/Fax

Practice location:
  • Phone: 141-432-7229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number5563-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: