Provider Demographics
NPI:1790979326
Name:OFENLOCK, CATHERINE E (PTA)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:E
Last Name:OFENLOCK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 S EMMETT ST
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:IL
Mailing Address - Zip Code:60135-1117
Mailing Address - Country:US
Mailing Address - Phone:815-784-3893
Mailing Address - Fax:
Practice Address - Street 1:245 W EXCHANGE ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-1495
Practice Address - Country:US
Practice Address - Phone:815-895-9227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant