Healthcare Provider Details

I. General information

NPI: 1982828521
Provider Name (Legal Business Name): ELIZABETH WHEELER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 LICK CREEK RD
ANNA IL
62906-3270
US

IV. Provider business mailing address

333 N WASHINGTON ST
DU QUOIN IL
62832-1770
US

V. Phone/Fax

Practice location:
  • Phone: 618-833-4300
  • Fax: 618-833-4336
Mailing address:
  • Phone: 618-542-2405
  • Fax: 618-542-9990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: