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NPI Code Detail

MEDICARE: KATELYN MARIE DERRIG OTR

MEDICARE: KATELYN MARIE DERRIG OTR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist056.011751IL
2225XP0200XPediatric Occupational Therapist056.011751IL

General Provider Information

NPI Number : 1497297667
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATELYN MARIE DERRIG OTR
Provider Business Mailing Address
First Line : 5 S BUSSE RD
Second Line :
City : MT PROSPECT
State : IL
Zip : 60056-2901
Country : US
Telephone Number : 224-935-7399
Fax Number :
Provider Business Practice Location Address
First Line : 5820 W IRVING PARK RD
Second Line :
City : CHICAGO
State : IL
Zip : 60634-2616
Country : US
Telephone Number : 773-685-8482
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2016
Last Update Date : 12/05/2025

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Directions to “ KATELYN MARIE DERRIG OTR” Practice Location

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