Healthcare Provider Details

I. General information

NPI: 1750215166
Provider Name (Legal Business Name): AUBREY ANNETTE MCCORMICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 ALTON SQ STE H1
ALTON IL
62002-5919
US

IV. Provider business mailing address

228 ALTON SQ STE H1
ALTON IL
62002-5919
US

V. Phone/Fax

Practice location:
  • Phone: 618-463-5171
  • Fax: 618-463-5175
Mailing address:
  • Phone: 618-463-5171
  • Fax: 618-463-5175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056017073
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: