Provider Demographics
NPI:1043590698
Name:MUKUHA, WINNIE WAMBUI (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:WINNIE
Middle Name:WAMBUI
Last Name:MUKUHA
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 1:573 DARLINGTON LN
Mailing Address - Street 2:APT5
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7742
Mailing Address - Country:US
Mailing Address - Phone:815-451-7281
Mailing Address - Fax:815-893-0039
Practice Address - Street 1:573 DARLINGTON LN
Practice Address - Street 2:APT5
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7742
Practice Address - Country:US
Practice Address - Phone:815-451-7281
Practice Address - Fax:815-893-0039
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056008016225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist