Active NPI
William J Vaughn
- Occupational Therapy Assistant
- Barry, IL
National Provider Identifier
1124589981
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 057003181
- Practice address
- 1313 Pratt St
Barry, IL 62312-1365 - Phone
- (217) 335-2326
- NPI assigned
- Mar 26, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 057003181 | IL | Primary |
Addresses
Primary practice location
1313 Pratt St
Barry, IL 62312-1365
Mailing address
PO Box 67
Freeman Spur, IL 62841-0067
Phone (618) 727-2263
Other practice location 1
2117 E Tyler Ave
Harlingen, TX 78550-7211
Phone (956) 440-0580
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| V250-9307-1179 | Other | IL | DRIVERS LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 057003181 | IL | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707436800000",
"number": "1124589981",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 67",
"city": "FREEMAN SPUR",
"state": "IL",
"postal_code": "628410067",
"telephone_number": "618-727-2263"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1313 PRATT ST",
"city": "BARRY",
"state": "IL",
"postal_code": "623121365",
"telephone_number": "217-335-2326"
}
],
"practiceLocations": [
{
"address_1": "2117 E Tyler Ave",
"address_purpose": "LOCATION",
"city": "Harlingen",
"state": "TX",
"postal_code": "785507211",
"country_code": "US",
"telephone_number": "956-440-0580",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VAUGHN",
"first_name": "WILLIAM",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-03-26",
"last_updated": "2024-02-09",
"certification_date": "2024-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "IL",
"license": "057003181",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVERS LICENSE",
"identifier": "V250-9307-1179",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Barry, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 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.