Provider Demographics
NPI:1144002734
Name:LOCKWOOD, KRISTIN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:CLEMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:527 BONNIEBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-1768
Mailing Address - Country:US
Mailing Address - Phone:847-505-6727
Mailing Address - Fax:
Practice Address - Street 1:527 BONNIEBROOK AVE
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-1768
Practice Address - Country:US
Practice Address - Phone:847-505-6727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007204225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist