Healthcare Provider Details

I. General information

NPI: 1679466791
Provider Name (Legal Business Name): MEGHAN RITTHALER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CARVER LN
EAST PEORIA IL
61611-3052
US

IV. Provider business mailing address

120 OSSAMI LAKE CT
MORTON IL
61550-1140
US

V. Phone/Fax

Practice location:
  • Phone: 309-282-6704
  • Fax:
Mailing address:
  • Phone: 630-484-3366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: