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General NPI Number Information
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NPI Number | 1841761707
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Entity Type | Individual
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Provider Name | KELSEY DYKEMA OTR
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Gender | Female
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Dates
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Enumeration Date | 12/17/2018
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Last Update Date | 12/17/2018
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Provider Practice Location Address
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Address Line | 7300 W DEAN RD
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City | MILWAUKEE
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State | WI
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Zip | 53223-2637
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Country | US
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Telephone | 414-371-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 3351 PRIMROSE LN
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City | YPSILANTI
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State | MI
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Zip | 48197-3216
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Country | US
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Telephone |
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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 |
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License Number State | WI
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