Minetta Wallingford, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

056.003498 Issued in IL

Practice address

423 Addison Rd
Riverside, IL 60546-2007

Phone

(773) 715-8463

NPI assigned

Dec 4, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Moxie OT PLLC

  • Rehabilitation Clinic/Center
  • Chicago, IL
  • NPI 1730776626
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1575417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575417600000",
    "number": "1174160634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "423 ADDISON RD",
            "city": "RIVERSIDE",
            "state": "IL",
            "postal_code": "605462007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "423 ADDISON RD",
            "city": "RIVERSIDE",
            "state": "IL",
            "postal_code": "605462007",
            "telephone_number": "773-715-8463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLINGFORD",
        "first_name": "MINETTA",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-12-04",
        "last_updated": "2019-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056.003498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Ann Vandervort, COTA
• Staci Michelle Vetrovsky, RD, LDN
• VHS of Illinois Inc
• Village of Riverside
• Diane Louise Wallendjack, EDD, NCSP
• Lee David Weiss, M.D.
• Sophia E Welykyj, MD
• Westeros Family Practice, LTD
• Carly Williamson, SSP, NCSP
• Valerie Wodzinski, RN, MS

• Occupational Therapist in Riverside, IL
• Providers in Riverside, IL by specialty
• Occupational Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2019; 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.