Provider Demographics
NPI:1386309086
Name:KASTENHOLZ, MICHELLE (OTR)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:KASTENHOLZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:7420 DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-8814
Mailing Address - Country:US
Mailing Address - Phone:612-747-0119
Mailing Address - Fax:
Practice Address - Street 1:7420 DEVONSHIRE DR
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-8814
Practice Address - Country:US
Practice Address - Phone:612-747-0119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3086225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist