Provider Demographics
NPI:1265102164
Name:SIFUENTES, KATHLEEN MELEI (OTD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MELEI
Last Name:SIFUENTES
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:MELEI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16304 S FIELDSTONE PL
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-7683
Mailing Address - Country:US
Mailing Address - Phone:815-416-8226
Mailing Address - Fax:
Practice Address - Street 1:3351 HOBSON RD STE B
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1689
Practice Address - Country:US
Practice Address - Phone:630-541-3652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.014274225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist