Healthcare Provider Details

I. General information

NPI: 1699481812
Provider Name (Legal Business Name): KATHERINE WEGRECKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date: 04/20/2026
Reactivation Date: 05/15/2026

III. Provider practice location address

7900 N MILWAUKEE AVE STE 7
NILES IL
60714-3172
US

IV. Provider business mailing address

7900 N MILWAUKEE AVE STE 7
NILES IL
60714-3172
US

V. Phone/Fax

Practice location:
  • Phone: 952-923-9066
  • Fax:
Mailing address:
  • Phone: 952-923-9066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number05601694
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: