Healthcare Provider Details

I. General information

NPI: 1134937907
Provider Name (Legal Business Name): KATE J TOENNIES OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2024
Last Update Date: 12/24/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4996 STATE ROUTE 159 SUITE B
MARYVILLE IL
62062
US

IV. Provider business mailing address

PO BOX 153
ALBERS IL
62215-0153
US

V. Phone/Fax

Practice location:
  • Phone: 618-288-4677
  • Fax:
Mailing address:
  • Phone: 618-795-3594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number016367
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: