Healthcare Provider Details

I. General information

NPI: 1306195334
Provider Name (Legal Business Name): KATIE MARIE RADIG MS/OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 W 20TH AVE
OSHKOSH WI
54904-6344
US

IV. Provider business mailing address

W5658 TONYS WAY
APPLETON WI
54915-2899
US

V. Phone/Fax

Practice location:
  • Phone: 920-424-0221
  • Fax:
Mailing address:
  • Phone: 920-428-5805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5220-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: