Healthcare Provider Details

I. General information

NPI: 1699417618
Provider Name (Legal Business Name): KATELIN ROGACKI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7421 MADISON ST
FOREST PARK IL
60130-1575
US

IV. Provider business mailing address

7421 MADISON ST
FOREST PARK IL
60130-1575
US

V. Phone/Fax

Practice location:
  • Phone: 847-909-1490
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056016649
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-209708
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: