Provider Demographics
NPI:1184516486
Name:KOSTUCHOWSKI, KAYLIN (OTR/L)
Entity type:Individual
Prefix:
First Name:KAYLIN
Middle Name:
Last Name:KOSTUCHOWSKI
Suffix:
Gender:F
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 1:2411 DEEPWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-2718
Mailing Address - Country:US
Mailing Address - Phone:715-340-0370
Mailing Address - Fax:
Practice Address - Street 1:1111 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-7804
Practice Address - Country:US
Practice Address - Phone:715-952-1029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-19
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8800-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist