Provider Demographics
NPI:1659527661
Name:KLYCZEK, DEBORAH (OTR/L)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:KLYCZEK
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 1:13784 EMPRESS LN
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-7069
Mailing Address - Country:US
Mailing Address - Phone:773-646-3513
Mailing Address - Fax:
Practice Address - Street 1:13321 S AVENUE M
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60633-1503
Practice Address - Country:US
Practice Address - Phone:773-646-3513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-09
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003520225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist