Provider Demographics
NPI:1386356673
Name:STILLING, IAN DAVID
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:DAVID
Last Name:STILLING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 TIMOTHY LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-3055
Mailing Address - Country:US
Mailing Address - Phone:815-355-1447
Mailing Address - Fax:
Practice Address - Street 1:1013 TIMOTHY LN
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-3055
Practice Address - Country:US
Practice Address - Phone:815-355-1447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.004489224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant