Healthcare Provider Details

I. General information

NPI: 1962054080
Provider Name (Legal Business Name): CHRISTINE ANN WOYTEK OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 BUTTERFIELD TRL
KANKAKEE IL
60901-2959
US

IV. Provider business mailing address

448 STONEGATE WAY
MANTENO IL
60950-3717
US

V. Phone/Fax

Practice location:
  • Phone: 815-936-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056002593
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: