Provider Demographics
NPI:1023698404
Name:FOWLER-UTANES, YVETTE G (OTR/L, MHA)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:G
Last Name:FOWLER-UTANES
Suffix:
Gender:F
Credentials:OTR/L, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 ROBIN GLEN LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-2210
Mailing Address - Country:US
Mailing Address - Phone:847-877-3632
Mailing Address - Fax:
Practice Address - Street 1:1950 LARKIN AVE
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5843
Practice Address - Country:US
Practice Address - Phone:847-600-4520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-10
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007875225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist