Healthcare Provider Details

I. General information

NPI: 1407958010
Provider Name (Legal Business Name): MILINDA A BIRKNER OTD,OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MINDY BIRKNER

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21921 DOVE LN
CARLYLE IL
62231-4717
US

IV. Provider business mailing address

21921 DOVE LN
CARLYLE IL
62231-4717
US

V. Phone/Fax

Practice location:
  • Phone: 618-971-6979
  • Fax: 618-749-2041
Mailing address:
  • Phone: 618-971-6979
  • Fax: 618-749-2041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056007264
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: