Provider Demographics
NPI:1063644870
Name:KEMOS, KRISTEN N (MOT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:N
Last Name:KEMOS
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:N
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2222
Mailing Address - Fax:630-759-6106
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:STE 120
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3417
Practice Address - Country:US
Practice Address - Phone:262-521-9762
Practice Address - Fax:262-521-1091
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.008748225X00000X
WI5013-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400161336Medicare PIN
WIP01402971Medicare PIN