MEDICARE: EMILY MACKENZIE TIMMERMANN OTD, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	056014314	IL

General Provider Information

NPI Number	:	1659067494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY MACKENZIE TIMMERMANN OTD, OTR/L

Provider Business Mailing Address
First Line	:	1725 HEATHWOOD DR
Second Line	:
City	:	NASHVILLE
State	:	IL
Zip	:	62263-1365
Country	:	US
Telephone Number	:	618-314-0798
Fax Number	:

Provider Business Practice Location Address
First Line	:	602 E JACKSON ST
Second Line	:
City	:	DU QUOIN
State	:	IL
Zip	:	62832-2429
Country	:	US
Telephone Number	:	618-542-3441
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2023
Last Update Date	:	04/14/2023

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