Provider Demographics
NPI:1285816835
Name:DUFFEE, KYLE (OT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:DUFFEE
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:2400 N SHEFFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2215
Practice Address - Country:US
Practice Address - Phone:773-281-7991
Practice Address - Fax:773-281-2590
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056008150225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619908OtherMEDICARE GROUP NUMBER
IL599990OtherMEDICARE GROUP NUMBER
IL600040OtherMEDICARE GROUP NUMBER
IL600040OtherMEDICARE GROUP NUMBER
IL1619908OtherMEDICARE GROUP NUMBER