Provider Demographics
NPI:1386234235
Name:KANTNER, KATHERINE IRENE (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:IRENE
Last Name:KANTNER
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 W ARMITAGE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1588
Mailing Address - Country:US
Mailing Address - Phone:630-244-1461
Mailing Address - Fax:
Practice Address - Street 1:6501 S PROMONTORY DR # 1003
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-1002
Practice Address - Country:US
Practice Address - Phone:773-256-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.013744225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL056.013744OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION