Provider Demographics
NPI:1992531917
Name:KAUFMAN, KOURTNEY (COTA/L)
Entity type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 SMALL FARM RD
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-1462
Mailing Address - Country:US
Mailing Address - Phone:414-943-0433
Mailing Address - Fax:
Practice Address - Street 1:2195 N SUMMIT VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-8675
Practice Address - Country:US
Practice Address - Phone:262-567-4662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7116-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant