Basic Information
| Provider Information | |||||||||
| NPI: | 1114036860 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MUSKOPF | ||||||||
| FirstName: | KURT | ||||||||
| MiddleName: | JON | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | OTRIL CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 APEX DR | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622491282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186510444 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5900 N ILLINOIS | ||||||||
| Address2: | STE 9 | ||||||||
| City: | FAIRVIEW HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3146211416 | ||||||||
| FaxNumber: | 6186249330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 01/31/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 056006024 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.