Provider Demographics
NPI:1588343354
Name:FOGARTY, CATHRYNE (OTR/L)
Entity type:Individual
Prefix:
First Name:CATHRYNE
Middle Name:
Last Name:FOGARTY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CATHRYNE
Other - Middle Name:
Other - Last Name:POTEMPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:613 S REX BLVD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-4258
Mailing Address - Country:US
Mailing Address - Phone:630-390-6627
Mailing Address - Fax:
Practice Address - Street 1:7125 JANES AVE STE 200
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2341
Practice Address - Country:US
Practice Address - Phone:630-541-3652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.011473225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist