Provider Demographics
NPI:1659513117
Name:DODICK, CYNTHIA M (OTR/L)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:DODICK
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 1:225 WESTMORELAND DR
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-3059
Mailing Address - Country:US
Mailing Address - Phone:847-853-6131
Mailing Address - Fax:847-853-6132
Practice Address - Street 1:225 WESTMORELAND DR
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-3059
Practice Address - Country:US
Practice Address - Phone:847-853-6131
Practice Address - Fax:847-853-6132
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.001563225X00000X, 225XE0001X, 225XH1200X, 225XN1300X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics