Provider Demographics
NPI:1336590777
Name:SINCLAIR, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SINCLAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20059 E 1ST RD
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:IL
Mailing Address - Zip Code:62560-5096
Mailing Address - Country:US
Mailing Address - Phone:217-710-0411
Mailing Address - Fax:
Practice Address - Street 1:511 N DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056-1027
Practice Address - Country:US
Practice Address - Phone:217-710-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227015622225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist