Healthcare Provider Details

I. General information

NPI: 1841969235
Provider Name (Legal Business Name): KATELYN OGRADY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 JOHNS DR
GLENVIEW IL
60025-1657
US

IV. Provider business mailing address

1311 MAMARONECK AVE STE 140
WHITE PLAINS NY
10605-5224
US

V. Phone/Fax

Practice location:
  • Phone: 847-707-6744
  • Fax: 847-786-2156
Mailing address:
  • Phone: 914-294-4050
  • Fax: 631-760-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056012742
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: