Provider Demographics
NPI:1710147335
Name:MANG, EMILY (OT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MANG
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 VILLAGE QUARTER RD
Mailing Address - Street 2:# A4
Mailing Address - City:WEST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-2163
Mailing Address - Country:US
Mailing Address - Phone:616-502-1666
Mailing Address - Fax:
Practice Address - Street 1:2326 W HIGGINS RD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-2413
Practice Address - Country:US
Practice Address - Phone:847-519-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.006917225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist