Provider Demographics
NPI:1992950893
Name:KRASSELT, KELLI JO (COTA)
Entity type:Individual
Prefix:MS
First Name:KELLI
Middle Name:JO
Last Name:KRASSELT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:209 WILDERNESS VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-8357
Mailing Address - Country:US
Mailing Address - Phone:715-389-6468
Mailing Address - Fax:715-389-6090
Practice Address - Street 1:209 WILDERNESS VIEW DR
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-8357
Practice Address - Country:US
Practice Address - Phone:715-389-6468
Practice Address - Fax:715-389-6090
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4612-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant