Healthcare Provider Details

I. General information

NPI: 1558617357
Provider Name (Legal Business Name): KATHLEEN PRATHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 07/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N LOGAN AVE THERAPY DEPARTMENT
DANVILLE IL
61832-3715
US

IV. Provider business mailing address

3902 CROWWOOD DR APT #203
CHAMPAIGN IL
61822-3585
US

V. Phone/Fax

Practice location:
  • Phone: 217-443-3106
  • Fax: 217-443-3187
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number057003270
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: