Healthcare Provider Details

I. General information

NPI: 1801725981
Provider Name (Legal Business Name): KAELEIGH WILLIS MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3109 MOUNT PLEASANT ST
RACINE WI
53404-1511
US

IV. Provider business mailing address

1500 HARMONY DR
RACINE WI
53402-3219
US

V. Phone/Fax

Practice location:
  • Phone: 262-635-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: