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Individual

KELLY KAY OTT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.

Contact information

Practice address
3860 W OGDEN AVE, CHICAGO, IL 60623-2460
(872) 588-3000
(872) 588-3021
Mailing address
3860 W OGDEN AVE, CHICAGO, IL 60623-2460
(872) 588-3000
(872) 588-3021

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085-004230
IL
363A00000X
Physician Assistant
Primary
085004230
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
085004230
STATE LICENSE
IL
01
1101248
SPECIALTY BOARDS
IL
01
385003022
CS LICENSE
IL
Enumeration date
11/29/2011
Last updated
03/07/2023
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