Provider Demographics
NPI:1346754934
Name:KRANZ, MARK JOSEPH (MOTR/L)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
Last Name:KRANZ
Suffix:
Gender:M
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16337 ALBERT DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-6556
Mailing Address - Country:US
Mailing Address - Phone:815-353-1669
Mailing Address - Fax:
Practice Address - Street 1:16337 ALBERT DR
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-6556
Practice Address - Country:US
Practice Address - Phone:815-353-1669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-19
Last Update Date:2017-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056008309225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist