Provider Demographics
NPI:1942646237
Name:EIRICH, KAITLIN MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:MARIE
Last Name:EIRICH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:MARIE
Other - Last Name:GOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:929 W HIGGINS RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60195-3203
Mailing Address - Country:US
Mailing Address - Phone:847-885-0078
Mailing Address - Fax:847-285-4240
Practice Address - Street 1:929 W HIGGINS RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60195-3203
Practice Address - Country:US
Practice Address - Phone:847-885-0078
Practice Address - Fax:847-285-4240
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.010161225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207937023Medicare PIN
IL207851026Medicare PIN