Most Relevant Information
Provider Data
| NPI Number: | 1003642760 |
| Provider Name: | PAYTON RISINGER OTD, OTR/L |
| Entity Type: | Individual |
| Taxonomy Code: | 225X00000X |
| Specialty: | Occupational Therapist |
| License Number: | 056.016228 |
Most Important Dates
| Enumeration Date: | 09/10/2024 |
| Last Updated: | 09/10/2024 |
Provider Practice Location
1095 PINGREE RD STE 209
CRYSTAL LAKE
IL
600141727
Practice Location Phone/Fax
| Phone: | 8474588890 |
| Fax: | 8474588889 |
Provider Mailing Location
431 BRANDY DR APT B
CRYSTAL LAKE
IL
600147470
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |