Provider Demographics
NPI:1972577567
Name:DEPAOLI, KARA LYNN
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:LYNN
Last Name:DEPAOLI
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 1:2619 W 59TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-2720
Mailing Address - Country:US
Mailing Address - Phone:217-377-6828
Mailing Address - Fax:
Practice Address - Street 1:465 42ND AVE
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-4044
Practice Address - Country:US
Practice Address - Phone:309-779-3490
Practice Address - Fax:309-779-5615
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007544225X00000X
IA01716225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist