Individual
KATHLEEN MARY ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1640 W ROOSEVELT RD, CHICAGO, IL 60608-1316
(312) 802-3141
Mailing address
1454 W ERIE ST APT 2E, CHICAGO, IL 60642-7483
(312) 451-9595
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056.014420
IL
Other
Enumeration date
09/17/2021
Last updated
09/17/2021
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