Provider Demographics
NPI:1275078289
Name:FRICKE, EMMA (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:FRICKE
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 SPINDLETREE AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-2885
Mailing Address - Country:US
Mailing Address - Phone:630-347-0176
Mailing Address - Fax:
Practice Address - Street 1:2319 N ORCHARD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3303
Practice Address - Country:US
Practice Address - Phone:773-755-7793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056011697225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist