Provider Demographics
NPI:1912727595
Name:VAN LANEN, KARI ELLEN (OTR)
Entity type:Individual
Prefix:MRS
First Name:KARI
Middle Name:ELLEN
Last Name:VAN LANEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:KARI
Other - Middle Name:ELLEN
Other - Last Name:KARWEDSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2955 FLOWERING PEACH DR
Mailing Address - Street 2:
Mailing Address - City:SUAMICO
Mailing Address - State:WI
Mailing Address - Zip Code:54313-3225
Mailing Address - Country:US
Mailing Address - Phone:920-309-2451
Mailing Address - Fax:
Practice Address - Street 1:3852 CREAMERY RD
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-9210
Practice Address - Country:US
Practice Address - Phone:920-338-9670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4366-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist