Provider Demographics
NPI:1306286836
Name:MCMAHON, KYLE W (OTR)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:W
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W175 N1117 STONEWOOD DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GERMANTOWN, WI
Mailing Address - State:WI
Mailing Address - Zip Code:53022
Mailing Address - Country:US
Mailing Address - Phone:715-579-9470
Mailing Address - Fax:
Practice Address - Street 1:W175 N1117 STONEWOOD DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GERMANTOWN, WI
Practice Address - State:WI
Practice Address - Zip Code:53022
Practice Address - Country:US
Practice Address - Phone:715-579-9470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4609-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist