Provider Demographics
NPI:1265866008
Name:TATE, MARIE (MOTS)
Entity Type:Individual
Prefix:MISS
First Name:MARIE
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:MOTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 S ADAMS
Mailing Address - Street 2:APT 202
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559
Mailing Address - Country:US
Mailing Address - Phone:507-841-3842
Mailing Address - Fax:
Practice Address - Street 1:10071 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1272
Practice Address - Country:US
Practice Address - Phone:815-464-6069
Practice Address - Fax:815-464-6970
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056010527225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist