Kathryn Boudouris, MS, OTR/L
Individual provider Active NPI Occupational Therapist · Mokena, IL
NPI 1811231129 · NPPES record last updated Nov 27, 2012
Key facts
- NPI
- 1811231129
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 056.009950 (IL)
- Practice address
- 19100 Crescent Dr
#101
Mokena, IL 60448-7510 - Phone
- (708) 478-5400
- NPI assigned
- Nov 27, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056.009950 | IL | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kids Can DO, Inc. | Occupational Therapist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 056.009950 | IL | Yes |
Addresses
Primary practice location
19100 Crescent Dr
#101
Mokena, IL 60448-7510
Mailing address
17064 Old Orchard LN N
Lockport, IL 60441-7412
Other providers in Mokena, IL
- Body in Sync Physical Therapy, LTD.
- Bone & Joint Surgeons, LTD
- Samantha Bonzani
- Katie Boothe
- Kerry Bouck
- Tara Boyles
- Braden Partners LP
- Rachel Michelle Brauer Dever
- Nicole D Bray
- Irene Bresingham
All providers in Mokena, IL · Occupational Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 27, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.