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General NPI Number Information
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NPI Number | 1265707558
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Entity Type | Individual
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Provider Name | MICHELLE JEAN KORT OT
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Gender | Female
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 7517 W COLDSPRING RD
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City | GREENFIELD
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State | WI
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Zip | 53220-2814
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Country | US
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Telephone | 414-327-6603
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Fax |
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Provider Business Mailing Address
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Address Line | 4908 PARTRIDGE WAY
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City | STEVENS POINT
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State | WI
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Zip | 54482-8645
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Country | US
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Telephone | 715-630-8654
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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 | 2782-26
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License Number State | WI
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