Provider Demographics
NPI:1336812262
Name:TODD, KAREN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:TODD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1334
Mailing Address - Country:US
Mailing Address - Phone:630-484-3169
Mailing Address - Fax:
Practice Address - Street 1:18 N CATHERINE AVE
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-5930
Practice Address - Country:US
Practice Address - Phone:708-482-9453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.014370225X00000X
IN99105590A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist