Healthcare Provider Details

I. General information

NPI: 1982071486
Provider Name (Legal Business Name): KATELYN SAMUELS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 BUSSE HWY UNIT C
PARK RIDGE IL
60068-3189
US

IV. Provider business mailing address

9500 BORMET DR STE 304
MOKENA IL
60448-8399
US

V. Phone/Fax

Practice location:
  • Phone: 224-267-0535
  • Fax:
Mailing address:
  • Phone: 815-469-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.011137
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: