Provider Demographics
NPI:1568037901
Name:SIUDYLA, KATARZYNA J (COTA)
Entity Type:Individual
Prefix:MRS
First Name:KATARZYNA
Middle Name:J
Last Name:SIUDYLA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 PLUM TREE DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-8371
Mailing Address - Country:US
Mailing Address - Phone:815-529-3707
Mailing Address - Fax:
Practice Address - Street 1:1061 PLUM TREE DR
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-8371
Practice Address - Country:US
Practice Address - Phone:815-529-3707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.005570224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant