Healthcare Provider Details

I. General information

NPI: 1770239048
Provider Name (Legal Business Name): MINDY HOEDEBECKE MOTR/L, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 N MAIN ST
ALTAMONT IL
62411-1446
US

IV. Provider business mailing address

1005 HEALTH CENTER DR STE 201
MATTOON IL
61938-4653
US

V. Phone/Fax

Practice location:
  • Phone: 618-881-0920
  • Fax: 618-881-0919
Mailing address:
  • Phone: 217-258-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056012290
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: