Provider Demographics
NPI:1538926647
Name:GOEBEL, KATHERINE (OTR/L)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:GOEBEL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4461 S RIVER RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-2471
Mailing Address - Country:US
Mailing Address - Phone:414-350-7911
Mailing Address - Fax:
Practice Address - Street 1:3200 S 103RD ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-4104
Practice Address - Country:US
Practice Address - Phone:414-441-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8476-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist