Provider Demographics
NPI:1861744757
Name:MASTNY, KATHERINE ELIZABETH (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:MASTNY
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 N LARRABEE ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1101
Mailing Address - Country:US
Mailing Address - Phone:317-371-4770
Mailing Address - Fax:
Practice Address - Street 1:1443 N LARRABEE ST
Practice Address - Street 2:UNIT B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-1101
Practice Address - Country:US
Practice Address - Phone:317-371-4770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056009060225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist