Provider Demographics
NPI:1740039965
Name:SCHAEFER, KATELYN ALEXIS (OTR/L)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:ALEXIS
Last Name:SCHAEFER
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 1:1220 READING DR APT 11201
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-2816
Mailing Address - Country:US
Mailing Address - Phone:270-724-2901
Mailing Address - Fax:
Practice Address - Street 1:1220 READING DR APT 11201
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-2816
Practice Address - Country:US
Practice Address - Phone:270-724-2901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.016033225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist