Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
ETHAN RIDENOUR, COTA/L
ActiveETHAN RIDENOUR, COTA/L is a Occupational Therapy Assistant healthcare provider located in CARROLLTON, Illinois. NPI 1912319039 is currently active in the NPPES registry. Verify at CMS.
Occupational Therapy Assistant · CARROLLTON, IL
Registration Details
- NPI Number
- 1912319039
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- May 22, 2014 (12.210208864946 yrs)
- Last Updated
- Oct 15, 2018
- Licenses
-
057001592 (IL)056004047 (IL)146010465 (IL)057004022 (IL)
Practice Information
- Address
-
320 4TH STREETCARROLLTON, IL, 620161135Browse IL providers · Browse ZIP 62016
- Phone
- 3143289362
- Fax
- 6186196881
- Primary Specialty
-
Occupational Therapy Assistant
224Z00000X
- Additional Specialty
- Occupational Therapist
- Additional Specialty
- Speech, Language and Hearing Specialist
- Additional Specialty
- Occupational Therapy Assistant
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.