Healthcare Provider Details

I. General information

NPI: 1679844005
Provider Name (Legal Business Name): KATHRYN LYNN MALICKI OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 W HISTORIC MITCHELL ST
MILWAUKEE WI
53204-3533
US

IV. Provider business mailing address

349 W JUNIPER DR
GRAFTON WI
53024-2269
US

V. Phone/Fax

Practice location:
  • Phone: 414-383-9526
  • Fax: 262-653-0853
Mailing address:
  • Phone: 414-383-9526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5122-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: