Provider Demographics
NPI:1598396517
Name:RODAWOLD, VALERIE KAY (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:KAY
Last Name:RODAWOLD
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BRENNER CT
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-1122
Mailing Address - Country:US
Mailing Address - Phone:708-825-5842
Mailing Address - Fax:
Practice Address - Street 1:215 BRENNER CT
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:IL
Practice Address - Zip Code:60417-1122
Practice Address - Country:US
Practice Address - Phone:708-825-5842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.012229225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics