1881063394 NPI number — MRS. KAITLYN ANN STRAUSS PTA

Table of content: MRS. KAITLYN ANN STRAUSS PTA (NPI 1881063394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881063394 NPI number — MRS. KAITLYN ANN STRAUSS PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STRAUSS
Provider First Name:
KAITLYN
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WIER
Provider Other First Name:
KAITLYN
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PTA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881063394
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7517 W COLD SPRING RD
Provider Second Line Business Mailing Address:
GREENFIELD REHABILITATION AGENCY
Provider Business Mailing Address City Name:
GREENFIELD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53220-2814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-327-6603
Provider Business Mailing Address Fax Number:
414-327-5411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7517 W COLD SPRING RD
Provider Second Line Business Practice Location Address:
GREENFIELD REHABILITATION AGENCY
Provider Business Practice Location Address City Name:
GREENFIELD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53220-2814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-327-6603
Provider Business Practice Location Address Fax Number:
414-327-5411
Provider Enumeration Date:
09/15/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2244 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)