Provider Demographics
NPI:1144487984
Name:HOLPERIN, KATHY MARIE (OT)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:MARIE
Last Name:HOLPERIN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1256
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:54521-1256
Mailing Address - Country:US
Mailing Address - Phone:715-479-7874
Mailing Address - Fax:
Practice Address - Street 1:3575 MONHEIM ROAD
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:WI
Practice Address - Zip Code:54519
Practice Address - Country:US
Practice Address - Phone:715-479-7874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI995 026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist