Provider Demographics
NPI:1982827549
Name:NUTLEY, MAUREEN L (DEVELOPMENTALTHERAPY)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:L
Last Name:NUTLEY
Suffix:
Gender:F
Credentials:DEVELOPMENTALTHERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 SUNBIRD DR
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-7117
Mailing Address - Country:US
Mailing Address - Phone:815-282-6826
Mailing Address - Fax:
Practice Address - Street 1:5415 SUNBIRD DR
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-7117
Practice Address - Country:US
Practice Address - Phone:815-282-6826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILMN11490400P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist