Provider Demographics
NPI:1871002493
Name:DEKONING, KYLIE (BS, COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:KYLIE
Middle Name:
Last Name:DEKONING
Suffix:
Gender:F
Credentials:BS, COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 CZACKI ST
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-4302
Mailing Address - Country:US
Mailing Address - Phone:815-988-5273
Mailing Address - Fax:
Practice Address - Street 1:2850 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-2394
Practice Address - Country:US
Practice Address - Phone:331-249-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.004695224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant