Provider Demographics
NPI:1437454071
Name:PLATZ, KELLY MARIE (DT, MS)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MARIE
Last Name:PLATZ
Suffix:
Gender:F
Credentials:DT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 W ORCHARD PL
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2463
Mailing Address - Country:US
Mailing Address - Phone:224-406-4222
Mailing Address - Fax:
Practice Address - Street 1:6046 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-4342
Practice Address - Country:US
Practice Address - Phone:773-586-8360
Practice Address - Fax:630-455-9481
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist