MEDICARE: KATHLEEN ANNE MICHOR OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist		WI

General Provider Information

NPI Number	:	1275966202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN ANNE MICHOR OTR/L

Provider Business Mailing Address
First Line	:	545 W DAYTON ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53703-1995
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 MEADOWLARK DR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53714-2629
Country	:	US
Telephone Number	:	608-204-3420
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2013
Last Update Date	:	04/09/2026

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