Provider Demographics
NPI:1629843354
Name:RADFORD, KAYLEY (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAYLEY
Middle Name:
Last Name:RADFORD
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 1:501 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246-1842
Mailing Address - Country:US
Mailing Address - Phone:618-704-5562
Mailing Address - Fax:
Practice Address - Street 1:400 E HILLVIEW AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-2607
Practice Address - Country:US
Practice Address - Phone:618-664-1622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056015800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist