Rebecca L Golladay, OTR-L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

056006902 Issued in IL

Practice address

212 Edwards Dr
Normal, IL 61761-2334

Phone

(309) 824-7417

NPI assigned

Jun 22, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Innovations Pediatric Therapy, LLC

  • Occupational Therapist
  • Bloomington, IL
  • NPI 1003356817

  Pediatrics

  NPD (past) Authorized official

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

{
    "created_epoch": "1182470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487030400000",
    "number": "1720284151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 EDWARDS DR",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617612334",
            "telephone_number": "309-824-7417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 EDWARDS DR",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617612334",
            "telephone_number": "309-824-7417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLLADAY",
        "first_name": "REBECCA",
        "middle_name": "L",
        "credential": "OTR-L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-22",
        "last_updated": "2017-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NC",
            "license": "5657",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "IL",
            "license": "056006902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sydney Marie Gilmer, FNP-C
• Kayla Gingerich, CRNA
• Joan Ellen Gjesfjeld, LICSW
• Catherine Gleason-Dintaman, CRNA
• Joshua Goetze, PT, DPT
• Miranda Leigh Gonzalez, APN, CNP
• Ajeet D Gordhan, M.D.
• Tammy Gordon, RN
• Panna U Goswami, MD
• Grace Medical Transport LLC

• Pediatric Occupational Therapist in Normal, IL
• Providers in Normal, IL by specialty
• Pediatric Occupational Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2017; 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.