Healthcare Provider Details

I. General information

NPI: 1508018136
Provider Name (Legal Business Name): JENNIFER LAUREN BURKHART OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER JOTI TAJDEEP KAUR LAUREN OTR/L

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1262 WINWOOD DR
LAKE FOREST IL
60045-1161
US

IV. Provider business mailing address

1262 WINWOOD DR
LAKE FOREST IL
60045-1161
US

V. Phone/Fax

Practice location:
  • Phone: 224-500-7797
  • Fax:
Mailing address:
  • Phone: 224-500-7797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT009797
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15183852
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.009713
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: