Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kennedy Lake

Individual provider Occupational Therapist · NPI 1679435408

Kennedy Lake is an Occupational Therapist in Mount Pleasant, Wisconsin. Licensed in Wisconsin. Registered with an NPI since 2025.

Licensed in
WI
In the registry since
2025

Practice location Address checks out

13250 Washington Ave
Mount Pleasant, WI 53177-1516
Phone: (262) 799-8330
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Occupational Therapist (primary) Taxonomy 225X00000X · Licence 9045 (WI)

Record details

NPI number1679435408
Entity typeIndividual (Type 1)
GenderNot disclosed
Sole proprietorNo
NPI enumeratedDecember 1, 2025
Last updated in NPPESDecember 23, 2025
Certification dateDecember 23, 2025
Mailing addressPo Box 735044, Chicago, IL 60673-5044

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