Healthcare Provider Details

I. General information

NPI: 1548220098
Provider Name (Legal Business Name): NATHAN WAYNE YEAGER OT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W MORTON AVE SUITE 16A
JACKSONVILLE IL
62650-3146
US

IV. Provider business mailing address

715 MAGNOLIA DR
CHATHAM IL
62629-1129
US

V. Phone/Fax

Practice location:
  • Phone: 217-245-4640
  • Fax: 217-245-4642
Mailing address:
  • Phone: 217-391-4314
  • Fax:

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: