Healthcare Provider Details

I. General information

NPI: 1346529468
Provider Name (Legal Business Name): KAY FOOTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2011
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 NE MADISON AVE
PEORIA IL
61602-1109
US

IV. Provider business mailing address

216 TIMBER LN
EAST PEORIA IL
61611-1920
US

V. Phone/Fax

Practice location:
  • Phone: 309-674-7874
  • Fax:
Mailing address:
  • Phone: 309-645-4112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number114309
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.008469
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: