Provider Demographics
NPI:1346413341
Name:TOMPKINS, KATHLEEN R (APSW OT)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:R
Last Name:TOMPKINS
Suffix:
Gender:F
Credentials:APSW OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:N62W24141 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-3633
Mailing Address - Country:US
Mailing Address - Phone:262-246-9639
Mailing Address - Fax:414-358-5005
Practice Address - Street 1:4757 N 76TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-4732
Practice Address - Country:US
Practice Address - Phone:414-358-4173
Practice Address - Fax:414-358-5005
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2006 1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical