Provider Demographics
NPI:1588102412
Name:SHUTVET, KRISTA MARIE (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:MARIE
Last Name:SHUTVET
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 S ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-6308
Mailing Address - Country:US
Mailing Address - Phone:847-239-0480
Mailing Address - Fax:847-359-3449
Practice Address - Street 1:2901 FINLEY RD STE 101
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1394
Practice Address - Country:US
Practice Address - Phone:630-792-1800
Practice Address - Fax:630-792-1801
Is Sole Proprietor?:No
Enumeration Date:2017-02-12
Last Update Date:2017-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.011808225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist