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General NPI Number Information
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NPI Number | 1639697998
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Entity Type | Individual
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Provider Name | KATHRYN DAVIS
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Gender | Female
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Dates
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Enumeration Date | 09/06/2017
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Last Update Date | 09/06/2017
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Provider Practice Location Address
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Address Line | 355 E ERIE ST
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City | CHICAGO
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State | IL
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Zip | 60611-3167
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Country | US
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Telephone | 312-238-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 100 FOREST PL APT 1504
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City | OAK PARK
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State | IL
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Zip | 60301-1127
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Country | US
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Telephone |
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Fax |
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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 | 225XL0004X
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Taxonomy Name | Low Vision Occupational Therapist
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License Number | 056.012078
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License Number State | IL
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