Healthcare Provider Details

I. General information

NPI: 1659522506
Provider Name (Legal Business Name): KAREN MATELING OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S MILWAUKEE AVE
LIBERTYVILLE IL
60048-3204
US

IV. Provider business mailing address

801 S MILWAUKEE AVE
LIBERTYVILLE IL
60048-3204
US

V. Phone/Fax

Practice location:
  • Phone: 847-367-3344
  • Fax: 847-549-6920
Mailing address:
  • Phone: 847-367-3344
  • Fax: 847-549-6920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056.001192
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: