Provider Demographics
NPI:1821311135
Name:FRECKLETON, KATHRYN
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:FRECKLETON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 N LINDEN ST
Mailing Address - Street 2:APT L108
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-5321
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 N LINDEN ST
Practice Address - Street 2:APT L108
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-5321
Practice Address - Country:US
Practice Address - Phone:309-224-2609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist