Provider Demographics
NPI:1386810935
Name:ECKROY, KATHY ANN (COTA/L)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
Last Name:ECKROY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 DOCTORS LN
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-3310
Mailing Address - Country:US
Mailing Address - Phone:309-833-5555
Mailing Address - Fax:309-836-2390
Practice Address - Street 1:8 DOPCTOR S LANE
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455
Practice Address - Country:US
Practice Address - Phone:309-833-5555
Practice Address - Fax:309-836-2390
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057000224224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant