Individual
KATHLEEN MARY KOHLBECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
N546 SCHROETER DR, RANDOM LAKE, WI 53075-1272
(920) 207-3550
(920) 994-4606
Mailing address
N546 SCHROETER DR, RANDOM LAKE, WI 53075-1272
(920) 207-3550
(920) 994-4606
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1704-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000080125
GROUP PROVIDER NUMBER
WI
Enumeration date
12/02/2007
Last updated
12/02/2007
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