Provider Demographics
NPI:1659067494
Name:TIMMERMANN, EMILY MACKENZIE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MACKENZIE
Last Name:TIMMERMANN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:MACKENZIE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD, OTR/L
Mailing Address - Street 1:1725 HEATHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62263-1365
Mailing Address - Country:US
Mailing Address - Phone:618-314-0798
Mailing Address - Fax:
Practice Address - Street 1:602 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-2429
Practice Address - Country:US
Practice Address - Phone:618-542-3441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056014314225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist