Provider Demographics
NPI:1861730319
Name:KUCHARCZYK, MICHELE (OTR)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:KUCHARCZYK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 LEONARD ST N
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:54669-1229
Mailing Address - Country:US
Mailing Address - Phone:608-786-2274
Mailing Address - Fax:
Practice Address - Street 1:713 LEONARD ST N
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:WI
Practice Address - Zip Code:54669-1229
Practice Address - Country:US
Practice Address - Phone:608-786-2274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2640-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist