Basic Information
| Provider Information | |||||||||
| NPI: | 1063874188 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KORNAUS | ||||||||
| FirstName: | KELSEY | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | W9334 BLUFF LN | ||||||||
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| City: | CAMBRIDGE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535239512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8105163986 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9401 OLD SAUK RD | ||||||||
| Address2: | |||||||||
| City: | MIDDLETON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535624409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082038102 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2016 | ||||||||
| LastUpdateDate: | 11/17/2016 | ||||||||
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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 | 225X00000X | 5838-26 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.