Provider Demographics
NPI:1164665071
Name:TARR, KATIE ELISSA (MPT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ELISSA
Last Name:TARR
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 KNOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-4224
Mailing Address - Country:US
Mailing Address - Phone:815-712-8915
Mailing Address - Fax:815-324-9107
Practice Address - Street 1:802 KNOTTINGHAM DR
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-4224
Practice Address - Country:US
Practice Address - Phone:815-712-8915
Practice Address - Fax:815-324-9107
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016644225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist