Healthcare Provider Details

I. General information

NPI: 1568873545
Provider Name (Legal Business Name): KRISTY ANN ULM MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2423 GLENWOOD AVE 2423 GLENWOOD AVENUE
JOLIET IL
60435-5483
US

IV. Provider business mailing address

2423 GLENWOOD AVE SPEECH TREE ASSOCIATES, A PROGRESSUS THERAPY COMPANY
JOLIET IL
60435-5483
US

V. Phone/Fax

Practice location:
  • Phone: 815-725-9992
  • Fax: 815-725-9993
Mailing address:
  • Phone: 815-725-9992
  • Fax: 815-725-9993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056.010528
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: