Individual
KASSANDRA R KOSTOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSOT
Contact information
Practice address
700 GENEVA PKWY N STE A, LAKE GENEVA, WI 53147-4594
(262) 249-3505
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
6675-26
WI
Other
Enumeration date
11/14/2019
Last updated
11/15/2021
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