Basic Information
| Provider Information | |||||||||
| NPI: | 1043699978 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ACKMAN | ||||||||
| FirstName: | CORRINNE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 ANCHOR RD | ||||||||
| Address2: | |||||||||
| City: | DIXON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610218829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8152881905 | ||||||||
| FaxNumber: | 8152881636 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 ANCHOR RD | ||||||||
| Address2: | |||||||||
| City: | DIXON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610218829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8152881905 | ||||||||
| FaxNumber: | 8152881636 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2015 | ||||||||
| LastUpdateDate: | 03/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 056.005546 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.