Whitney Nicole Horrell, COTA
Individual provider Active NPI Occupational Therapy Assistant · Red Bud, IL
NPI 1629617279 · NPPES record last updated Dec 30, 2019
Key facts
- NPI
- 1629617279
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 057005332 (IL)
- Practice address
- 10161 Pine Crest Rd
Red Bud, IL 62278-4458 - Phone
- (618) 615-3984
- NPI assigned
- Dec 30, 2019
- 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 |
|---|---|---|---|
| 057005332 | IL | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 057005332 | IL | Yes |
Addresses
Primary practice location
10161 Pine Crest Rd
Red Bud, IL 62278-4458
Mailing address
10161 Pine Crest Rd
Red Bud, IL 62278-4458
Phone (618) 615-3984
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 057005332 | Other | IL | CERTIFICATION |
Other providers in Red Bud, IL
- Ashley N Hentis
- Hess Dental
- Annamarie Kathleen Hess
- Tara Hollinshead
- Natalie Marie Horrell
- Katelyn Houba
- Human Service Center
- Human Service Center of Southern Metro-East
- Interior Plains Emergency Physicians
- Inwood Emergency Physicians, LLC
All providers in Red Bud, 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 Dec 30, 2019. 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.