Megan Childress, COTA
Individual provider Active NPI Occupational Therapy Assistant · Brighton, IL
NPI 1134548050 · NPPES record last updated Apr 8, 2014
Key facts
- NPI
- 1134548050
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 057004007 (IL)
- Practice address
- 120 Virginia St
Brighton, IL 62012-1018 - Phone
- (618) 918-1036
- NPI assigned
- Apr 8, 2014
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 057004007 | IL | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 057004007 | IL | Yes |
Addresses
Primary practice location
120 Virginia St
Brighton, IL 62012-1018
Mailing address
120 Virginia
Brighton, IL 62012
Phone (618) 918-1036
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 165285321 | Medicaid | IL |
Other providers in Brighton, IL
- Dena L Bachman
- Valerie L Behrends
- Kimberly Broyles
- Nicole R Cummings
- William M Dondanville
- Jada L Elik
- Janice M. Gremaud
- Karen L Heineman
All providers in Brighton, IL · Occupational Therapy Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 8, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.