MEDICARE: HOLLY GRACE LUNDSTEDT MSOT, 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	056.016976	IL

General Provider Information

NPI Number	:	1568397974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY GRACE LUNDSTEDT MSOT, OTR/L

Provider Business Mailing Address
First Line	:	32 PHEASANT RUN
Second Line	:
City	:	HAWTHORN WOODS
State	:	IL
Zip	:	60047-9785
Country	:	US
Telephone Number	:	847-334-3199
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 W WEBSTER AVE STE 202
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-4892
Country	:	US
Telephone Number	:	847-971-3771
Fax Number	:

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

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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