Provider Demographics
NPI:1518489269
Name:ABERNATHY, KYLIE (OT)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15158 129TH ST
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-7493
Mailing Address - Country:US
Mailing Address - Phone:630-243-8960
Mailing Address - Fax:
Practice Address - Street 1:4735 WILLOW SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6130
Practice Address - Country:US
Practice Address - Phone:708-352-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist