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General NPI Number Information
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NPI Number | 1962388165
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Entity Type | Individual
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Provider Name | KATHRYN RACHAEL GUSTAFSON OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/13/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 35 N 28TH ST
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City | SUPERIOR
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State | WI
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Zip | 54880-5557
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Country | US
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Telephone | 320-583-6118
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Fax |
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Provider Business Mailing Address
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Address Line | 115 PLEASANT AVE NE
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City | COKATO
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State | MN
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Zip | 55321-4534
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Country | US
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Telephone | 320-583-6118
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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 | 8984-26
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License Number State | WI
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