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General NPI Number Information
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NPI Number | 1699279604
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Entity Type | Individual
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Provider Name | KIM KRYSTAL KOIKE OTR
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Gender | Female
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 06/07/2023
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Provider Practice Location Address
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Address Line | 3712 FIDDLERS CREEK DR.
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City | WAUKESHA
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State | WI
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Zip | 53188
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Country | US
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Telephone | 314-640-4724
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Fax |
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Provider Business Mailing Address
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Address Line | 2014 S 102ND ST APT 309
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City | WEST ALLIS
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State | WI
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Zip | 53227-1350
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Country | US
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Telephone | 314-640-4724
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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 | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number | 001148
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 001148
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 001148
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 6645-26
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License Number State | WI
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