Provider Demographics
NPI:1235818154
Name:SERIKAKU, KATHLEEN MEGUMI (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MEGUMI
Last Name:SERIKAKU
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 1:5105 S. WILLOW SPRINGS RD.
Mailing Address - Street 2:BUILDING 4
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525
Mailing Address - Country:US
Mailing Address - Phone:708-245-2600
Mailing Address - Fax:630-856-2634
Practice Address - Street 1:5105 S. WILLOW SPRINGS RD.
Practice Address - Street 2:BUILDING 4
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525
Practice Address - Country:US
Practice Address - Phone:708-245-2600
Practice Address - Fax:630-856-2634
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.000622225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist