Healthcare Provider Details

I. General information

NPI: 1669697843
Provider Name (Legal Business Name): CARMEN LYNN KUTSCH OTR L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 DOVER CIR
RACINE WI
53406-1419
US

IV. Provider business mailing address

2448 DOVER CIR
RACINE WI
53406-1419
US

V. Phone/Fax

Practice location:
  • Phone: 262-884-4617
  • Fax:
Mailing address:
  • Phone: 262-884-4617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056002483
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: