Individual
DIANNA KACZMAREK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
9244 29TH AVE, KENOSHA, WI 53143-6602
(262) 694-0080
(262) 942-7395
Mailing address
5604 APRICOT CT, GREENDALE, WI 53129-1711
(414) 421-2636
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2689-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41811700
—
WI
Enumeration date
04/14/2008
Last updated
04/14/2008
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