Provider Demographics
NPI:1740484724
Name:KEMEN, JEFFREY ALLEN (OTRL)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALLEN
Last Name:KEMEN
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3900 WASHINGTON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5717
Mailing Address - Country:US
Mailing Address - Phone:847-336-2616
Mailing Address - Fax:847-336-2676
Practice Address - Street 1:3900 WASHINGTON ST
Practice Address - Street 2:SUITE B
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5717
Practice Address - Country:US
Practice Address - Phone:847-336-2616
Practice Address - Fax:847-336-2676
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist