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NPI Code Detail

MEDICARE: PROF. JOSHUA CHASE HUMPHREY O.T.R.

MEDICARE: PROF. JOSHUA CHASE HUMPHREY O.T.R.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist056.012055IL
2225X00000XOccupational TherapistOTT.200092LA

General Provider Information

NPI Number : 1326239492
Entity Type Code : Individual
Provider Name (Legal Business Name) : PROF. JOSHUA CHASE HUMPHREY O.T.R.
Provider Business Mailing Address
First Line : 17370 TIMBER DR
Second Line :
City : STERLING
State : IL
Zip : 61081-9281
Country : US
Telephone Number : 815-440-4596
Fax Number : 225-791-0095
Provider Business Practice Location Address
First Line : 1201 1ST AVE
Second Line :
City : MENDOTA
State : IL
Zip : 61342-1815
Country : US
Telephone Number : 815-539-6745
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2007
Last Update Date : 05/16/2025

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