Provider Demographics
NPI:1407832033
Name:KIRK, DENA LEIGH (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:DENA
Middle Name:LEIGH
Last Name:KIRK
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 1:14132 BEAR POINT RD
Mailing Address - Street 2:
Mailing Address - City:SESSER
Mailing Address - State:IL
Mailing Address - Zip Code:62884-2417
Mailing Address - Country:US
Mailing Address - Phone:618-625-6280
Mailing Address - Fax:
Practice Address - Street 1:100 S PARK AVE
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3610
Practice Address - Country:US
Practice Address - Phone:618-942-3088
Practice Address - Fax:618-942-7116
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist