Provider Demographics
NPI:1699369801
Name:COAKLEY, KATIE (OTR/L)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:COAKLEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5353 N MAGNET AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1215
Mailing Address - Country:US
Mailing Address - Phone:847-227-7863
Mailing Address - Fax:
Practice Address - Street 1:9501 AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-1505
Practice Address - Country:US
Practice Address - Phone:847-227-7863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-28
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist