Provider Demographics
NPI:1104284520
Name:MAXWELL, KATHERINE (OTR/L)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 S ELM BLVD
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-5805
Mailing Address - Country:US
Mailing Address - Phone:217-377-6437
Mailing Address - Fax:
Practice Address - Street 1:110 S LOMBARD ST
Practice Address - Street 2:
Practice Address - City:MAHOMET
Practice Address - State:IL
Practice Address - Zip Code:61853-9202
Practice Address - Country:US
Practice Address - Phone:217-586-9999
Practice Address - Fax:217-210-9488
Is Sole Proprietor?:No
Enumeration Date:2016-01-29
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.007891225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist