Provider Demographics
NPI:1083254908
Name:FLYNN BLACKLEY, NATALIE (OTD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:FLYNN BLACKLEY
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 PARK MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1577
Mailing Address - Country:US
Mailing Address - Phone:217-473-4151
Mailing Address - Fax:
Practice Address - Street 1:165 PARK MEADOW LN
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1577
Practice Address - Country:US
Practice Address - Phone:217-473-4151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist