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General NPI Number Information
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NPI Number | 1700198124
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Entity Type | Organization
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Legal Business Name | WAUWATOSA THERAPIES LLC
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Dates
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Enumeration Date | 07/14/2010
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Last Update Date | 07/14/2010
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Provider Practice Location Address
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Address Line | 515 NORTH GLENVIEW AVENUE
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City | WAUWATOSA
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State | WI
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Zip | 53213-3234
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Country | US
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Telephone | 414-763-6996
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Fax | 414-221-0057
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Provider Business Mailing Address
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Address Line | 2473 NORTH 60TH STREET
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City | WAUWATOSA
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State | WI
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Zip | 53210-2222
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Country | US
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Telephone | 414-763-6996
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Fax | 414-221-0057
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JENNIFER LYNN KEBBEKUS
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Credential | MS, OTR
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Telephone | 414-763-6996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 4408-26
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License Number State | WI
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