Healthcare Provider Details

I. General information

NPI: 1285599787
Provider Name (Legal Business Name): NEAL JUAN COELHO OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 N 27TH ST
DECATUR IL
62526-2191
US

IV. Provider business mailing address

1303 W RIVERVIEW AVE
DECATUR IL
62522-2721
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-4975
  • Fax:
Mailing address:
  • Phone: 618-967-1558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.016531
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: