Provider Demographics
NPI:1053398230
Name:VAN LEEUWEN, KATHERINE (OT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:VAN LEEUWEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:BERQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2525 KANEVILLE RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2578
Practice Address - Country:US
Practice Address - Phone:630-584-1411
Practice Address - Fax:630-513-2630
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-003684225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCF2064OtherRAILROAD GROUP
IL753210OtherMEDICARE GROUP
ILCF2064OtherRAILROAD GROUP