MEDICARE: NATASHA TERWILLIGER

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
1	224Z00000X	Occupational Therapy Assistant	057003906	IL

General Provider Information

NPI Number	:	1649865627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATASHA TERWILLIGER

Provider Business Mailing Address
First Line	:	6412 TOWNSHIP ROAD 1400 E
Second Line	:
City	:	WYOMING
State	:	IL
Zip	:	61491-9116
Country	:	US
Telephone Number	:	309-238-1852
Fax Number	:

Provider Business Practice Location Address
First Line	:	6412 TOWNSHIP ROAD 1400 E
Second Line	:
City	:	WYOMING
State	:	IL
Zip	:	61491-9116
Country	:	US
Telephone Number	:	309-238-1852
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2021
Last Update Date	:	03/10/2021

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