Healthcare Provider Details

I. General information

NPI: 1548696362
Provider Name (Legal Business Name): MARY KATHLEEN KUCHTA MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY KATHLEEN MALONEY MS, OTR/L

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13049 S 71ST AVE
PALOS HEIGHTS IL
60463-2117
US

IV. Provider business mailing address

13049 S 71ST AVE
PALOS HEIGHTS IL
60463-2117
US

V. Phone/Fax

Practice location:
  • Phone: 708-805-0173
  • Fax:
Mailing address:
  • Phone: 708-805-0173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056010311
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: