KENNEDY LAKE
NPI 1679435408
Occupational Therapist in Mount Pleasant, WI

Active since December 01, 2025
13250 WASHINGTON AVE, MOUNT PLEASANT, WI 53177(262) 799-8330 Get Directions Write a Review

NPPES record last updated: December 23, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Dec 23, 2025, Dec 1, 2025 (2 updates tracked since 2025).

About Kennedy Lake NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENNEDY LAKE (NPI 1679435408) is an individual occupational therapist in Mount Pleasant, Wisconsin, licensed in Wisconsin (9045) and active in the NPI registry since December 2025.

NPPES Registry Identity

NPI1679435408
Entity TypeIndividual
Primary Taxonomy225X00000X
Provider Legal NameKENNEDY LAKE
Location Address13250 WASHINGTON AVEMount Pleasant, WI 53177-1516
Mailing AddressPo Box 735044Chicago, IL 60673-5044 · (800) 326-2250
Sole ProprietorNo
Enumeration DateDecember 1, 2025
Last NPPES UpdateDecember 23, 20252 updates tracked since enumeration
NPPES CertifiedDecember 23, 2025
NPI 1679435408 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyOccupational TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Taxonomy Code225X00000X
License Licensed in WI · 9045
Definition
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 experience required by the occupational therapy program; has passed a nationally recognized entry-level examination for occupational therapists, and fulfills state requirements for licensure, certification, or registration. An occupational therapist provides interventions based on evaluation and which emphasize the therapeutic use of everyday life activities (i.e., occupations) with individuals or groups for the purpose of facilitating participation in roles and situations and in home, school, workplace, community and other settings. Occupational therapy services are provided for the purpose of promoting health and wellness and are provided to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction. Occupational therapists address the physical, cognitive, psychosocial, sensory, and other aspects of occupational performance in a variety of contexts to support engagement in everyday life activities that affect health, well-being, and quality of life.
13250 WASHINGTON AVE, Mount Pleasant, WI 53177

Other Identifiers 1

Medicaid100390531WI

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Nurse Anesthetist, Certified Registered
13250 WASHINGTON AVE
MOUNT PLEASANT, WI 53177
Registered Nurse
13250 WASHINGTON AVE
MT PLEASANT, WI 53177
Emergency Medicine
13250 WASHINGTON AVE
MOUNT PLEASANT, WI 53177
Surgery
13250 WASHINGTON AVE
MOUNT PLEASANT, WI 53177
Obstetrics & Gynecology
13250 WASHINGTON AVE
MOUNT PLEASANT, WI 53177
Physician Assistant
13250 WASHINGTON AVE
MOUNT PLEASANT, WI 53177
Nurse Anesthetist, Certified Registered
13250 WASHINGTON AVE
MOUNT PLEASANT, WI 53177
Emergency Medicine
13250 WASHINGTON AVE
MOUNT PLEASANT, WI 53177

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kennedy Lake's NPI number?

The NPI number for Kennedy Lake is 1679435408. It was assigned to this individual provider in the NPPES registry on December 1, 2025.

Where is Kennedy Lake located?

Kennedy Lake practices at 13250 Washington Ave, Mount Pleasant, WI 53177. The listed phone number is (262) 799-8330.

What is Kennedy Lake's specialty?

The primary specialty registered for this NPI is Occupational Therapist with taxonomy code 225X00000X.

When was this NPI record last updated?

The NPPES record for Kennedy Lake was last updated on December 23, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.