Provider Demographics
NPI:1285182287
Name:KIDD, EVELYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:KIDD
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 1:371 TANOAK CT
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-4465
Mailing Address - Country:US
Mailing Address - Phone:609-442-9790
Mailing Address - Fax:
Practice Address - Street 1:371 TANOAK CT
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-4465
Practice Address - Country:US
Practice Address - Phone:609-442-9790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2016-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.011652225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist