Provider Demographics
NPI:1740300300
Name:ANDERSON, KAY W (OTR L)
Entity type:Individual
Prefix:MS
First Name:KAY
Middle Name:W
Last Name:ANDERSON
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 1:9052 W HEATHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-5801
Mailing Address - Country:US
Mailing Address - Phone:847-663-2300
Mailing Address - Fax:847-663-2400
Practice Address - Street 1:9811 WOODS DR
Practice Address - Street 2:H 190
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1074
Practice Address - Country:US
Practice Address - Phone:847-663-2300
Practice Address - Fax:847-663-2400
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics