Provider Demographics
NPI:1528112935
Name:CORMIER, MYLENE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MYLENE
Middle Name:
Last Name:CORMIER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13400 S ROUTE 59
Mailing Address - Street 2:SUITE 116-326
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-5696
Mailing Address - Country:US
Mailing Address - Phone:815-267-7334
Mailing Address - Fax:630-429-9411
Practice Address - Street 1:13400 S ROUTE 59
Practice Address - Street 2:SUITE 116-326
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-5696
Practice Address - Country:US
Practice Address - Phone:815-267-7334
Practice Address - Fax:630-429-9411
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-004242225XP0200X, 225X00000X, 225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0009932171Medicare UPIN