Provider Demographics
NPI:1366859381
Name:WOTAL, KATHI L (LAC)
Entity type:Individual
Prefix:MRS
First Name:KATHI
Middle Name:L
Last Name:WOTAL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 E NORTHWEST HIGHWAY
Mailing Address - Street 2:#1
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-6944
Mailing Address - Country:US
Mailing Address - Phone:478-873-0032
Mailing Address - Fax:
Practice Address - Street 1:1800 E NORTHWEST HIGHWAY
Practice Address - Street 2:#1
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-6944
Practice Address - Country:US
Practice Address - Phone:478-873-0032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001160171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist