Poettker Pediatric Therapy Services, P.C

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

2013002846 Issued in IL

Legal business name

POETTKER PEDIATRIC THERAPY SERVICES, P.C

Practice address

14163 Jem Dr
Aviston, IL 62216-3646

Phone

(618) 228-7229

Fax

(618) 228-7229

NPI assigned

May 13, 2014

Organization subpart

No

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

Authorized official

Name

Mrs. Neely Reanna Poettker, MOT, OTR/LNPI 1144479619

Title

Occupational Thearpist

Phone

(618) 401-3210

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Neely R. Poettker, M.S., OTR/L

  • Occupational Therapist
  • Aviston, IL
  • NPI 1144479619
  NPD (past) Authorized official

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

{
    "created_epoch": "1399939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399939200000",
    "number": "1275944175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14163 JEM DR",
            "city": "AVISTON",
            "state": "IL",
            "postal_code": "622163646",
            "telephone_number": "618-228-7229",
            "fax_number": "618-228-7229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14163 JEM DR",
            "city": "AVISTON",
            "state": "IL",
            "postal_code": "622163646",
            "telephone_number": "618-228-7229",
            "fax_number": "618-228-7229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POETTKER PEDIATRIC THERAPY SERVICES, P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-13",
        "last_updated": "2014-05-13",
        "status": "A",
        "authorized_official_last_name": "POETTKER",
        "authorized_official_first_name": "NEELY",
        "authorized_official_middle_name": "REANNA",
        "authorized_official_title_or_position": "OCCUPATIONAL THEARPIST",
        "authorized_official_telephone_number": "618-401-3210",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MOT, OTR/L"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "IL",
            "license": "2013002846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Palladian Aviston SNF LLC
• Brett Peek
• Kim R Peek, LCSW
• Blair Elizabeth Pierson, FNP-C
• David Pierson
• Neely R. Poettker, M.S., OTR/L
• Progressive Housing, Inc.
• Trauma Treatment & Training PLLC
• Amber Marie Watts, MOT, OTR/L
• Dana Leigh Wolfslau, M.A., CCC/SLP

• All providers in Aviston, IL
• Pediatric Occupational Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2014; 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.