Provider Demographics
NPI:1699552877
Name:O'BRENNAN, KACEY JO (DPT)
Entity type:Individual
Prefix:
First Name:KACEY
Middle Name:JO
Last Name:O'BRENNAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KACEY
Other - Middle Name:JO
Other - Last Name:HOTTES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:2001 BUTTERFIELD RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1211
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:
Practice Address - Street 1:50 COMMONS WAY STE D
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-3490
Practice Address - Country:US
Practice Address - Phone:256-624-9722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH12138225100000X
SC225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist