Provider Demographics
NPI:1174725881
Name:POLLARD, ELLYN M (OTR)
Entity type:Individual
Prefix:
First Name:ELLYN
Middle Name:M
Last Name:POLLARD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7429 CLAREWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5340
Mailing Address - Country:US
Mailing Address - Phone:847-543-1236
Mailing Address - Fax:
Practice Address - Street 1:LAKE FOREST HOSPITAL
Practice Address - Street 2:660 WESTMORELAND DR.
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045
Practice Address - Country:US
Practice Address - Phone:847-535-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist