Felecia Marie Ivanuck, COTA/L
Individual provider Active NPI Occupational Therapy Assistant · Godfrey, IL
NPI 1346906013 · NPPES record last updated Nov 16, 2021
Key facts
- NPI
- 1346906013
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 057.005215 (IL)
- Practice address
- 812 Airport Rd
Godfrey, IL 62035-2920 - Phone
- (618) 466-2134
- NPI assigned
- Nov 16, 2021
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|
| 057.005215 | IL | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 057.005215 | IL | Yes |
Addresses
Primary practice location
812 Airport Rd
Godfrey, IL 62035-2920
Mailing address
812 Airport Rd
Godfrey, IL 62035-2920
Phone (618) 466-2134
Other providers in Godfrey, IL
- James Melvin Hudson
- Bethany E Huelskoetter
- Lindsay Anne Hueneger
- Andrew Ibisch
- Illini Optometric PC
- Lisa K James
- Jeanie M. Thompson, MD PC
- Judith Bohringer
- Ordie H. King Jr.
- Julie Ann Kline
All providers in Godfrey, 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 Nov 16, 2021. 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.