Basic Information
Provider Information | |||||||||
NPI: | 1568873545 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ULM | ||||||||
FirstName: | KRISTY | ||||||||
MiddleName: | ANN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MOT, OTR/L | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2423 GLENWOOD AVE | ||||||||
Address2: | SPEECH TREE ASSOCIATES, A PROGRESSUS THERAPY COMPANY | ||||||||
City: | JOLIET | ||||||||
State: | IL | ||||||||
PostalCode: | 604355483 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8157259992 | ||||||||
FaxNumber: | 8157259993 | ||||||||
Practice Location | |||||||||
Address1: | 2423 GLENWOOD AVE | ||||||||
Address2: | 2423 GLENWOOD AVENUE | ||||||||
City: | JOLIET | ||||||||
State: | IL | ||||||||
PostalCode: | 604355483 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8157259992 | ||||||||
FaxNumber: | 8157259993 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/13/2014 | ||||||||
LastUpdateDate: | 05/13/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | 056.010528 | IL | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.