Provider Demographics
NPI:1124308291
Name:CUTSHALL, KARA JANE
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:JANE
Last Name:CUTSHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13400 S ROUTE 59
Mailing Address - Street 2:SUITE 116-326
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-5696
Mailing Address - Country:US
Mailing Address - Phone:815-267-7334
Mailing Address - Fax:630-429-9411
Practice Address - Street 1:13400 S ROUTE 59
Practice Address - Street 2:SUITE 116-326
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-5696
Practice Address - Country:US
Practice Address - Phone:815-267-7334
Practice Address - Fax:630-429-9411
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.010188225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist