Provider Demographics
NPI:1043699978
Name:ACKMAN, CORRINNE ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:
First Name:CORRINNE
Middle Name:ELIZABETH
Last Name:ACKMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ANCHOR RD
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-8829
Mailing Address - Country:US
Mailing Address - Phone:815-288-1905
Mailing Address - Fax:815-288-1636
Practice Address - Street 1:500 ANCHOR RD
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-8829
Practice Address - Country:US
Practice Address - Phone:815-288-1905
Practice Address - Fax:815-288-1636
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.005546225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist