Individual
JACKIE KUCHARSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1249 W LIEBAU RD, MEQUON, WI 53092-3396
(262) 243-4161
Mailing address
PO BOX 735041, CHICAGO, IL 60673-5041
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3143
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41055200
—
WI
Enumeration date
03/29/2007
Last updated
09/20/2023
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