Provider Demographics
NPI:1952823932
Name:WENBERG, KAREN GAY (COTA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:GAY
Last Name:WENBERG
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1470
Mailing Address - Country:US
Mailing Address - Phone:708-408-1192
Mailing Address - Fax:
Practice Address - Street 1:7222 W CERMAK RD STE 500
Practice Address - Street 2:
Practice Address - City:NORTH RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-1443
Practice Address - Country:US
Practice Address - Phone:708-442-0023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.004456224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant