MEDICARE: KATHRYN CHAMPAGNE OTR/L

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
1	225X00000X	Occupational Therapist	056.011860	IL

General Provider Information

NPI Number	:	1528594611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN CHAMPAGNE OTR/L

Provider Business Mailing Address
First Line	:	1670 N CLAREMONT AVE APT 110
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5375
Country	:	US
Telephone Number	:	989-709-6328
Fax Number	:

Provider Business Practice Location Address
First Line	:	6959 W 64TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638
Country	:	US
Telephone Number	:	708-257-4696
Fax Number	:	773-912-6954

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2017
Last Update Date	:	05/24/2018

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Directions to “ KATHRYN CHAMPAGNE OTR/L” Practice Location

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