1750609079 NPI number — MS. KATHY HOOYENGA OTR/L , ATP, RET

Table of content: MS. KATHY HOOYENGA OTR/L , ATP, RET (NPI 1750609079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750609079 NPI number — MS. KATHY HOOYENGA OTR/L , ATP, RET

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOOYENGA
Provider First Name:
KATHY
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L , ATP, RET
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750609079
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1640 W ROOSEVELT RD
Provider Second Line Business Mailing Address:
RM 415
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60608-1316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-996-3196
Provider Business Mailing Address Fax Number:
312-413-3709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1640 W ROOSEVELT RD
Provider Second Line Business Practice Location Address:
RM 415
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60608-1316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-996-3196
Provider Business Practice Location Address Fax Number:
312-413-3709
Provider Enumeration Date:
05/11/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XE0001X , with the licence number:  056.003142 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XP0019X , with the licence number: 056.003142 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com