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General NPI Number Information
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NPI Number | 1568873545
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Entity Type | Individual
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Provider Name | KRISTY ANN ULM MOT, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/13/2014
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Last Update Date | 05/13/2014
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Provider Practice Location Address
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Address Line | 2423 GLENWOOD AVE 2423 GLENWOOD AVENUE
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City | JOLIET
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State | IL
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Zip | 60435-5483
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Country | US
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Telephone | 815-725-9992
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Fax | 815-725-9993
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Provider Business Mailing Address
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Address Line | 2423 GLENWOOD AVE SPEECH TREE ASSOCIATES, A PROGRESSUS THERAPY COMPANY
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City | JOLIET
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State | IL
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Zip | 60435-5483
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Country | US
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Telephone | 815-725-9992
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Fax | 815-725-9993
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 056.010528
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License Number State | IL
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