Healthcare Provider Details

I. General information

NPI: 1083254908
Provider Name (Legal Business Name): NATALIE FLYNN BLACKLEY OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 09/11/2025
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 PARK MEADOW LN
BOLINGBROOK IL
60440-1577
US

IV. Provider business mailing address

165 PARK MEADOW LN
BOLINGBROOK IL
60440-1577
US

V. Phone/Fax

Practice location:
  • Phone: 217-473-4151
  • Fax:
Mailing address:
  • Phone: 217-473-4151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number21900
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: