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General NPI Number Information
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NPI Number | 1790979326
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Entity Type | Individual
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Provider Name | CATHERINE E OFENLOCK P.T.A.
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Gender | Female
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Dates
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Enumeration Date | 08/27/2007
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Last Update Date | 08/27/2007
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Provider Practice Location Address
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Address Line | 245 W EXCHANGE ST SUITE 4
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City | SYCAMORE
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State | IL
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Zip | 60178-1495
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Country | US
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Telephone | 815-895-9227
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Fax |
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Provider Business Mailing Address
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Address Line | 240 S EMMETT ST
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City | GENOA
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State | IL
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Zip | 60135-1117
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Country | US
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Telephone | 815-784-3893
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State | IL
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