Provider Demographics
NPI:1306652250
Name:WENNSTROM, KARISSA JOY (OTD, OTR)
Entity type:Individual
Prefix:DR
First Name:KARISSA
Middle Name:JOY
Last Name:WENNSTROM
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 DEEP LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-7271
Mailing Address - Country:US
Mailing Address - Phone:847-417-1311
Mailing Address - Fax:
Practice Address - Street 1:2833 N CLYBOURN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-8470
Practice Address - Country:US
Practice Address - Phone:847-604-0027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist