Basic Information
| Provider Information | |||||||||
| NPI: | 1003019035 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAMINSKI | ||||||||
| FirstName: | KATY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 LAWE ST | ||||||||
| Address2: | |||||||||
| City: | KAUKAUNA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 541302022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9207663741 | ||||||||
| FaxNumber: | 9207664217 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 LAWE ST | ||||||||
| Address2: | |||||||||
| City: | KAUKAUNA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 541302022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9207663741 | ||||||||
| FaxNumber: | 9207664217 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2007 | ||||||||
| LastUpdateDate: | 08/13/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | 3986-046 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.