Provider Demographics
NPI:1689255572
Name:AUBRY, CYNTHIA ANN
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:AUBRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 FIELDS SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-3733
Mailing Address - Country:US
Mailing Address - Phone:217-239-2849
Mailing Address - Fax:217-356-7964
Practice Address - Street 1:2501 FIELDS SOUTH DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-3733
Practice Address - Country:US
Practice Address - Phone:217-239-2849
Practice Address - Fax:217-356-7964
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0056005517225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics