Individual provider · NPI-1

Kim Krystal Koike, OTR

Occupational Therapist · Waukesha, WI

NPI number1699279604
StatusActive
Last updated in NPPESJun 7, 2023

Details

NPI
1699279604
Entity type
Individual (NPI-1)
Name
Kim Krystal Koike
Credential
OTR
Sex
Female
Sole proprietor
Yes
Enumeration date
Mar 23, 2018
Certification date
Jun 7, 2023
Last updated
Jun 7, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
225X00000X Occupational Therapist6645-26WIYes
2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine001148MO
2083X0100X Preventive Medicine, Occupational Medicine001148MO
208VP0014X Pain Medicine, Interventional Pain Medicine001148MO
225X00000X Occupational Therapist––

Practice location

3712 Fiddlers Creek Dr.
Waukesha, WI 53188

Phone 314-640-4724

Mailing address

2014 S 102nd St Apt 309
West Allis, WI 53227-1350

Phone 314-640-4724

Other practice locations

5737 Erie St
Racine, WI 53402-1970

Phone 314-640-4724

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