Provider Demographics
NPI:1043496888
Name:COSTELLO, KATHRYN
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 E OAKTON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4905
Mailing Address - Country:US
Mailing Address - Phone:847-274-9529
Mailing Address - Fax:847-274-9529
Practice Address - Street 1:602 E OAKTON ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4905
Practice Address - Country:US
Practice Address - Phone:847-274-9529
Practice Address - Fax:847-274-9529
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist