Provider Demographics
NPI:1114682150
Name:WILLIAMS, KATHERINE (OTD)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3627 N KEELER AVE # 3N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-3014
Mailing Address - Country:US
Mailing Address - Phone:949-648-2735
Mailing Address - Fax:
Practice Address - Street 1:150 E HURON ST STE 803
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2912
Practice Address - Country:US
Practice Address - Phone:312-640-2473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.014550225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL056.014550OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
IL462755OtherNATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY, INC. OTR