Provider Demographics
NPI:1710693510
Name:KRAMER, OTTO JR
Entity Type:Individual
Prefix:
First Name:OTTO
Middle Name:
Last Name:KRAMER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15255 S 94TH AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3800
Mailing Address - Country:US
Mailing Address - Phone:708-280-5640
Mailing Address - Fax:
Practice Address - Street 1:15255 S 94TH AVE FL 5
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3800
Practice Address - Country:US
Practice Address - Phone:708-280-5640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.014778225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist