Kim Lee Hackett, COTA
Individual provider Active NPI Occupational Therapy Assistant · Marshall, WI
NPI 1699178996 · NPPES record last updated Sep 30, 2014
Key facts
- NPI
- 1699178996
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 5119-27 (WI)
- Practice address
- 425 Farnham St
Apt. 6
Marshall, WI 53559-9624 - Phone
- (608) 320-9203
- NPI assigned
- Sep 30, 2014
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5119-27 | WI | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 5119-27 | WI | Yes |
Addresses
Primary practice location
425 Farnham St
Apt. 6
Marshall, WI 53559-9624
Mailing address
425 Farnham St
Apt. 6
Marshall, WI 53559
Phone (608) 320-9203
Other providers in Marshall, WI
- Maxwell Clark
- Dane County EMS District No 14
- Nikki Lee Frisch
- Laura Gillis
- Tiffany Chanel Gray
- Christine Haugen
- Kathleen Homan
- Lisa Huffer
- Denise M James
- JT School Dist 2 Village of Marshall Et Al
All providers in Marshall, WI · Occupational Therapy Assistant in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 30, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.