Healthcare Provider Details

I. General information

NPI: 1407094931
Provider Name (Legal Business Name): KATHLEEN KOTECKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N WINFIELD RD STE 430
WINFIELD IL
60190-1379
US

IV. Provider business mailing address

25 N WINFIELD RD STE 430
WINFIELD IL
60190-1379
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-1500
  • Fax:
Mailing address:
  • Phone: 630-933-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.015938
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070015938
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: