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General NPI Number Information
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NPI Number | 1144487984
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Entity Type | Individual
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Provider Name | KATHY MARIE HOLPERIN O.T.
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Gender | Female
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 3575 MONHEIM ROAD
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City | CONOVER
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State | WI
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Zip | 54519
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Country | US
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Telephone | 715-479-7874
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1256
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City | EAGLE RIVER
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State | WI
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Zip | 54521-1256
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Country | US
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Telephone | 715-479-7874
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 995 026
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License Number State | WI
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