Provider Demographics
NPI:1730773433
Name:KAYES, SABRINA MALLORY (COTA/L)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:MALLORY
Last Name:KAYES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4142 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:STICKNEY
Mailing Address - State:IL
Mailing Address - Zip Code:60402-4338
Mailing Address - Country:US
Mailing Address - Phone:312-841-6999
Mailing Address - Fax:
Practice Address - Street 1:9777 N GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1002
Practice Address - Country:US
Practice Address - Phone:847-967-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.005519224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant