Provider Demographics
NPI:1609258755
Name:CONNOLLY, EMILY (MOTR/L)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9834 S HAMLIN AVE
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-3363
Mailing Address - Country:US
Mailing Address - Phone:708-921-2300
Mailing Address - Fax:
Practice Address - Street 1:9834 S HAMLIN AVE
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-3363
Practice Address - Country:US
Practice Address - Phone:708-921-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.010673225X00000X
IL056010673225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty