Provider Demographics
NPI:1174968143
Name:RATWAY, KIMBERLY (OTR)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:RATWAY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 S COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-7101
Mailing Address - Country:US
Mailing Address - Phone:815-334-8134
Mailing Address - Fax:
Practice Address - Street 1:2914 S COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-7101
Practice Address - Country:US
Practice Address - Phone:815-334-8134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-05
Last Update Date:2013-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.001997225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist