Provider Demographics
NPI:1962388165
Name:GUSTAFSON, KATHRYN RACHAEL (OTR/L)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:RACHAEL
Last Name:GUSTAFSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:115 PLEASANT AVE NE
Mailing Address - Street 2:
Mailing Address - City:COKATO
Mailing Address - State:MN
Mailing Address - Zip Code:55321-4534
Mailing Address - Country:US
Mailing Address - Phone:320-583-6118
Mailing Address - Fax:
Practice Address - Street 1:35 N 28TH ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-5557
Practice Address - Country:US
Practice Address - Phone:320-583-6118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8984-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist