Provider Demographics
NPI:1043567720
Name:KLEBENOW, MATTHEW REIOT (OT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:REIOT
Last Name:KLEBENOW
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Gender:M
Credentials:OT
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Mailing Address - Street 1:333 NORTH MADISON
Mailing Address - Street 2:PROVENA SAINT JOSEPH MEDICAL CENTER
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435
Mailing Address - Country:US
Mailing Address - Phone:815-741-7416
Mailing Address - Fax:815-741-0774
Practice Address - Street 1:852A SHARP DRIVE
Practice Address - Street 2:PROVENA PHYSICAL THERAPY & INDUSTRIAL REHAB. CENTER
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404
Practice Address - Country:US
Practice Address - Phone:815-741-7416
Practice Address - Fax:815-741-0774
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL056.004830225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist