MEDICARE: MRS. JENNIFER LYNN KEBBEKUS MS, OTR

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	225X00000X	Occupational Therapist	4408	WI

General Provider Information

NPI Number	:	1467546002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER LYNN KEBBEKUS MS, OTR

Provider Business Mailing Address
First Line	:	530 N 108TH PL
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-4253
Country	:	US
Telephone Number	:	414-727-5552
Fax Number	:	414-727-5553

Provider Business Practice Location Address
First Line	:	530 N 108TH PL
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-4253
Country	:	US
Telephone Number	:	414-727-5552
Fax Number	:	414-727-5553

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	02/11/2020

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