Provider Demographics
NPI:1801211784
Name:SUMNER, EMILY (OTR)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SUMNER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTA
Mailing Address - Street 1:3905 W ERNESTINE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5800
Mailing Address - Country:US
Mailing Address - Phone:618-993-6237
Mailing Address - Fax:618-997-3529
Practice Address - Street 1:3905 W ERNESTINE DR
Practice Address - Street 2:SUITE B
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5800
Practice Address - Country:US
Practice Address - Phone:618-993-6237
Practice Address - Fax:618-997-3529
Is Sole Proprietor?:No
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056010457225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist