Provider Demographics
NPI:1215281332
Name:KESL-DEWEES, JO ELLEN (OT/L)
Entity type:Individual
Prefix:MS
First Name:JO
Middle Name:ELLEN
Last Name:KESL-DEWEES
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4537 STEIN AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-1731
Mailing Address - Country:US
Mailing Address - Phone:608-712-5485
Mailing Address - Fax:
Practice Address - Street 1:4537 STEIN AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-1731
Practice Address - Country:US
Practice Address - Phone:608-712-5485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4140-26225X00000X
IL056.004142225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist