Provider Demographics
NPI:1003851080
Name:FLYNN, JANE MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:MARIE
Last Name:FLYNN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 FLETCHER DR STE 304
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4756
Mailing Address - Country:US
Mailing Address - Phone:847-888-3131
Mailing Address - Fax:847-888-3359
Practice Address - Street 1:750 FLETCHER DR STE 304
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4756
Practice Address - Country:US
Practice Address - Phone:847-888-3131
Practice Address - Fax:847-888-3359
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102950225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1244Medicare PIN