Mary Kirchberg, OTR
Individual provider Active NPI Occupational Therapist · De Forest, WI
NPI 1871653485 · NPPES record last updated Jan 15, 2015
Key facts
- NPI
- 1871653485
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 3927-026 (WI)
- Practice address
- 4200 Savannah Dr
De Forest, WI 53532-2909 - Phone
- (608) 417-3370
- NPI assigned
- Dec 12, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|
| 3927-026 | WI | MD | Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 3927-026 | WI | Yes |
Addresses
Primary practice location
4200 Savannah Dr
De Forest, WI 53532-2909
Mailing address
202 S Park St
Madison, WI 53715-1507
Phone (608) 417-6000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 187653485 | Medicaid | WI |
Other providers in De Forest, WI
- Here I Am Healing, LLC
- Patricia Herschleb
- Holistic Home Health & Wellness, LLC
- Pamela Ferne Hunt
- Sarah Elizabeth Jones
- Judy Renee Klimt
- Kathy Lynn Marquardt
- Jennifer M Matte
- Zachary Scott McCallum
- Cynthia Joy McGivern
All providers in De Forest, WI · Occupational Therapist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 15, 2015. 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.