Provider Demographics
NPI:1760504054
Name:O'CONNOR, KRISTINE C (PT)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:C
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LARKSPUR LN
Mailing Address - Street 2:
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514-1015
Mailing Address - Country:US
Mailing Address - Phone:630-325-8851
Mailing Address - Fax:
Practice Address - Street 1:143 BERNICE DR
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-3366
Practice Address - Country:US
Practice Address - Phone:630-350-2736
Practice Address - Fax:630-350-2842
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-0064383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist