Provider Demographics
NPI:1851430169
Name:KLEINFELDER, MARIJO KAY (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:MARIJO
Middle Name:KAY
Last Name:KLEINFELDER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18440 CLYDE RD
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430
Mailing Address - Country:US
Mailing Address - Phone:708-957-9575
Mailing Address - Fax:
Practice Address - Street 1:19100 CRESCENT DR
Practice Address - Street 2:SUITE 101 KIDS CAN DO, INC
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-7510
Practice Address - Country:US
Practice Address - Phone:708-478-5400
Practice Address - Fax:708-478-5300
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056004024225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist