Individual provider · Type 1 NPI

Kennedy Lake

Occupational Therapist · Mount Pleasant, WI

NPI number 1679435408 Active

Practice location

13250 Washington Ave
Mount Pleasant, WI 53177-1516

Call (262) 799-8330 Map

Mailing address

PO Box 735044
Chicago, IL 60673-5044

Specialties and licenses

TaxonomyCodeLicense
Occupational Therapist Primary 225X00000X9045 (WI)

Occupational Therapist: An occupational therapist is a person who has graduated from an entry-level occupational therapy program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) or predecessor organizations, or approved by the World Federation of Occupational Therapists (WFOT), or an equivalent international occupational therapy education program; has successfully completed a period of supervised fieldwork…

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About NPI 1679435408

Kennedy Lake's National Provider Identifier is 1679435408, issued on Dec 1, 2025. The primary taxonomy on file is Occupational Therapist (225X00000X), and the practice location is in Mount Pleasant, WI. The record was last updated on Dec 23, 2025.