Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056.001563 | IL |
N | 225XE0001X | Environmental Modification | 056.001563 | IL |
N | 225XH1200X | Occupational Therapist - Hand | 056.001563 | IL |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 056.001563 | IL |
N | 225XP0200X | Occupational Therapist - Pediatrics | 056.001563 | IL |
NPI | 1659513117 |
---|---|
Provider Name | Cynthia M Dodick |
First Address | Wilmette, IL 60091-3059 |
Second Address | Wilmette, IL 60091-3059 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2009 |
Last Update Date | 31/03/2009 |