Patricia K Vantrease, COTA
Individual provider Active NPI Early Intervention Provider Agency · Zeigler, IL
NPI 1265758643 · NPPES record last updated Apr 11, 2010
Key facts
- NPI
- 1265758643
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Early Intervention Provider Agency 252Y00000X
- License
- 057001953 (IL)
- Practice address
- 206 S Pine St
Zeigler, IL 62999-1248 - Phone
- (618) 218-1832
- NPI assigned
- Apr 11, 2010
- 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 |
|---|---|---|---|
| 057001953 | IL | MD | Early Intervention Provider Agency |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Early Intervention Provider Agency | 252Y00000X | 057001953 | IL | Yes |
Addresses
Primary practice location
206 S Pine St
Zeigler, IL 62999-1248
Mailing address
206 S Pine St
Zeigler, IL 62999-1248
Phone (618) 218-1832
Other providers in Zeigler, IL
- Convenient Medical Care Clinic LLC
- Heather Jo Gulley
- Christina Denise McClure
- Sherry Ann Risley
- Regina Kay Spurlock
All providers in Zeigler, IL · Early Intervention Provider Agency 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 11, 2010. 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.