Healthcare Provider Details

I. General information

NPI: 1164066940
Provider Name (Legal Business Name): JULIE MARIE KAPPAS MOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 N MARION ST
OAK PARK IL
60302-1530
US

IV. Provider business mailing address

2500 W BRADLEY PL STE 109
CHICAGO IL
60618-4716
US

V. Phone/Fax

Practice location:
  • Phone: 844-478-6878
  • Fax:
Mailing address:
  • Phone: 773-332-9439
  • Fax: 773-754-8730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056.013185
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: