Provider Demographics
NPI:1124777123
Name:RITSCHE, KEITH ALAN (OTR/L)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:ALAN
Last Name:RITSCHE
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N7169 E PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-9403
Mailing Address - Country:US
Mailing Address - Phone:920-887-7545
Mailing Address - Fax:
Practice Address - Street 1:1738 EAGAN RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3736
Practice Address - Country:US
Practice Address - Phone:218-590-6530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7134-26225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics