Healthcare Provider Details

I. General information

NPI: 1518903749
Provider Name (Legal Business Name): MICHELLE C PAULOWSKE OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE C BLASI OT

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 LAKEVIEW PARKWAY
PLEASANT PRAIRIE WI
53158
US

IV. Provider business mailing address

3601 30TH AVE STE 103
KENOSHA WI
53144
US

V. Phone/Fax

Practice location:
  • Phone: 262-697-7295
  • Fax: 262-697-9412
Mailing address:
  • Phone: 262-657-0222
  • Fax: 626-657-7190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3855026
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: