Provider Demographics
NPI:1972244481
Name:WAYHART, KATHRYN SUZANNE
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:SUZANNE
Last Name:WAYHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26W155 MEADOWVIEW CT
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-1311
Mailing Address - Country:US
Mailing Address - Phone:847-857-8104
Mailing Address - Fax:
Practice Address - Street 1:110 WINDSOR PARK DR
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-1986
Practice Address - Country:US
Practice Address - Phone:877-817-0803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.014153225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist