Provider Demographics
NPI:1326714882
Name:CYRIER, KAITLIN MARIE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:MARIE
Last Name:CYRIER
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2648 W AUGUSTA BLVD # G
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-8266
Mailing Address - Country:US
Mailing Address - Phone:815-751-0817
Mailing Address - Fax:
Practice Address - Street 1:3516 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5732
Practice Address - Country:US
Practice Address - Phone:815-344-0246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-25
Deactivation Date:2021-08-16
Deactivation Code:
Reactivation Date:2021-08-25
Provider Licenses
StateLicense IDTaxonomies
IL056.014384225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist