Stormy Christen Edwards, COTA
Individual provider Active NPI Occupational Therapy Assistant · Petersburg, IL
NPI 1457532574 · NPPES record last updated Nov 16, 2007
Key facts
- NPI
- 1457532574
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- Practice address
- 19130 Sunny Acres Rd
Petersburg, IL 62675-7306 - Phone
- (217) 632-2334
- NPI assigned
- Nov 16, 2007
- 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 |
|---|---|---|---|
| 057.001299 | IL | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | IL | Yes |
Addresses
Primary practice location
19130 Sunny Acres Rd
Petersburg, IL 62675-7306
Mailing address
503 N Springfield Rd
Athens, IL 62613-9477
Phone (217) 632-2334
Other providers in Petersburg, IL
- County of Menard
- County of Menard
- John Charles Curry
- Paul Douglas Davis
- Veronica Lee Dombroski-Speaks
- Michael Gensler
- Gleason Pharmacy Services Inc
- Gleason Pharmacy Services Inc
- Timothy Arthur Gleason
- Christine Grisham
All providers in Petersburg, 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, 2007. 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.