Provider Demographics
NPI:1518585157
Name:KOSITZKY, CLAIRE IRENE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:IRENE
Last Name:KOSITZKY
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 1:17131 WARBLER LN
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-8808
Mailing Address - Country:US
Mailing Address - Phone:708-528-9612
Mailing Address - Fax:
Practice Address - Street 1:70 KEN HAYES DR
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-9379
Practice Address - Country:US
Practice Address - Phone:708-829-0059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.013630225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL224000162Medicaid