Healthcare Provider Details

I. General information

NPI: 1568397974
Provider Name (Legal Business Name): HOLLY GRACE LUNDSTEDT MSOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 W WEBSTER AVE STE 202
CHICAGO IL
60614-4892
US

IV. Provider business mailing address

32 PHEASANT RUN
HAWTHORN WOODS IL
60047-9785
US

V. Phone/Fax

Practice location:
  • Phone: 847-971-3771
  • Fax:
Mailing address:
  • Phone: 847-334-3199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.016976
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: