Provider Demographics
NPI:1124676176
Name:MERIGOLD, KATIE MARIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:MERIGOLD
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 1:1724 PEACHTREE DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-4738
Mailing Address - Country:US
Mailing Address - Phone:708-785-5215
Mailing Address - Fax:
Practice Address - Street 1:6020 151ST ST
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-1841
Practice Address - Country:US
Practice Address - Phone:708-687-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist