Provider Demographics
NPI:1932314119
Name:DRUMMER, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:DRUMMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 W TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1621
Mailing Address - Country:US
Mailing Address - Phone:309-691-3800
Mailing Address - Fax:309-689-3613
Practice Address - Street 1:1913 W TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1621
Practice Address - Country:US
Practice Address - Phone:309-691-3800
Practice Address - Fax:309-689-3613
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL56003848225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist