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Organization

KIDNECTIVITY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JENIFER BATES (BUSINESS DIRECTOR)
(847) 239-2177
Entity
Organization

Contact information

Practice address
600 WAUKEGAN RD STE 132, NORTHBROOK, IL 60062-1249
(847) 748-8733
(847) 739-7164
Mailing address
600 WAUKEGAN RD STE 132, NORTHBROOK, IL 60062-1249
(847) 748-8733

Taxonomy

Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
056005840
IL

Other

Enumeration date
12/22/2014
Last updated
09/11/2025
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