Fern Reardon, OTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

057.003454 Issued in IL

Practice address

1200 E Partridge St
Metamora, IL 61548-9619

Phone

(309) 367-4300

NPI assigned

Sep 11, 2024

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

• Fern Button Former name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 11, 2024.

{
    "created_epoch": "1726012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726012800000",
    "number": "1063248482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "247 E DELWOOD ST",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "615502512",
            "telephone_number": "309-267-8541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 E PARTRIDGE ST",
            "city": "METAMORA",
            "state": "IL",
            "postal_code": "615489619",
            "telephone_number": "309-367-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REARDON",
        "first_name": "FERN",
        "credential": "OTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-11",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "IL",
            "license": "057.003454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "FERN",
            "last_name": "BUTTON",
            "credential": "OTA/L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• All providers in Metamora, IL
• Occupational Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.