ETHAN RIDENOUR


Address: 320 4th Street, Carrollton, IL 62016-1135
Phone: 3143289362

ETHAN RIDENOUR (NPI# 1912319039) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1912319039
Entity Type Individual
Full Name ETHAN RIDENOUR
Credential COTA/L
Practice Address 320 4th Street
Carrollton
IL 62016-1135
Practice Telephone 3143289362
Practice Fax Number 6186196881
Mailing Telephone 3143289362
Mailing Fax Number 6186196881
Enumeration Date 2014-05-22
Last Update Date 2018-10-15
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 224Z00000X Occupational Therapy Assistant 057001592 IL Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Y 224Z00000X Occupational Therapy Assistant 057004022 IL Respiratory, Developmental, Rehabilitative and Restorative Service Providers
N 225X00000X Occupational Therapist 056004047 IL Respiratory, Developmental, Rehabilitative and Restorative Service Providers
N 235Z00000X Speech-Language Pathologist 146010465 IL Speech, Language and Hearing Service Providers

Other Provider Identifier

State Issuer Identifier Type Code
IL MEDICARE 1912319039 01

Provider Secondary Practice Location

Address Telephone Number Fax Number
610 Lowry St, Pittsfield, IL 623631768 2172855200

Office Location

Street Address 320 4TH STREET
City CARROLLTON
State IL
Zip Code 62016-1135

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1831209972 Dee Anna Darr Speech-Language Pathologist 109 2nd St, Carrollton, IL 62016 2006-08-30
1023125283 Lisa A Hart Chiropractor 307 6th St, Carrollton, IL 62016 2006-08-24
1972536761 R Scott Beavers Dentist 403 Locust, Carrollton, IL 62016 2006-07-08
1568557593 Pharmacy Plus Inc Pharmacy 508 N Main St, Carrollton, IL 62016-1027 2006-10-04
1700148194 Hamel Chiropractic Clinic LLC Chiropractor 425 N Main St, Carrollton, IL 62016-1136 2012-06-12
1184986754 Justin Kyle Hamel Chiropractor 425 N Main St, Carrollton, IL 62016-1136 2012-06-11
1275779415 All Hart Chiropractic Inc Clinic/Center 307 6th St, Carrollton, IL 62016-1247 2008-12-17
1427270941 James Uhles Pediatrics 523 S Main St, Carrollton, IL 62016-1251 2007-05-03
1932234622 Illini Medical Associates Sc Family Medicine 523 S Main St, Carrollton, IL 62016-1251 2007-02-22
1619934304 Michael S Mcnear Family Medicine 523 S Main St, Carrollton, IL 62016-1251 2006-04-27
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Taxonomy Information

Taxonomy Code 224Z00000X
Grouping Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Classification Occupational Therapy Assistant

Taxonomy Definition

An occupational therapy assistant is a person who has graduated from an occupational therapy assistant program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) or predecessor organizations, has successfully completed a period of supervised fieldwork experience required by the accredited occupational therapy assistant program, has passed a nationally recognized entry-level examination for occupational therapy assistants, and fulfills state requirements for licensure, certification, or registration. An occupational therapy assistant provides interventions under the supervision of an occupational therapist which emphasize the therapeutic use of everyday life activities (i.e., occupations) with individuals or groups for the purpose of facilitating participation in roles and situations and in home, school, workplace, community and other settings. Occupational therapy services are provided for the purpose of promoting health and wellness and are provided to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction. Occupational therapy assistants address the physical, cognitive, psychosocial, sensory, and other aspects of occupational performance in a variety of contexts to support engagement in everyday life activities that affect health, well-being, and quality of life.
Notes: Source: The Guide to Occupational Therapy Practice, 2nd edition. Bethesda: American Occupational Therapy Association, 2007. [7/1/2008: definition changed, source changed]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1184106411 Cindy T Vu Occupational Therapy Assistant 1877 Cheyenne, Carrollton, TX 75010 2018-09-04
1154612174 Tarah Michelle Hinton Occupational Therapy Assistant 2060 Burrow Rd Sw, Carrollton, OH 44615-8236 2011-04-25
1326645938 Chelsi Broemser-bennett Occupational Therapy Assistant 1000 W Crosby Rd Ste 136, Carrollton, TX 75006-6904 2020-10-06
1780142398 Chantale Alexis Meyer Occupational Therapy Assistant 1000 W Crosby Rd Ste 136, Carrollton, TX 75006-6904 2019-03-04
1336621887 Joe A Gonzalez Occupational Therapy Assistant 1855 Cheyenne Dr, Carrollton, TX 75010-2201 2018-08-31
1316429152 Demond Turner Occupational Therapy Assistant 1000 W Crosby Rd Ste 136, Carrollton, TX 75006-6904 2018-08-29
1508346867 Gerald Callis Occupational Therapy Assistant 2537 Golden Bear Dr, Carrollton, TX 75006-2377 2018-08-16
1225539240 Jamie Foo Occupational Therapy Assistant 1000 W Crosby Rd Ste 136, Carrollton, TX 75006-6904 2018-02-25
1972003481 Lindsey Bishop Occupational Therapy Assistant 1000 W Crosby Rd, Carrollton, TX 75006-6935 2018-02-20

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1356940886 Kathleen Pumo Occupational Therapy Assistant 300 W 22nd St, Lombard, IL 60148-5417 2020-10-26
1093314593 Melissa Eileen Suermann Occupational Therapy Assistant 300 S Station Rd, Glen Carbon, IL 62034-2739 2020-10-26
1265049746 Lauren Bryant Occupational Therapy Assistant 17042 Wausau Ave, South Holland, IL 60473-3352 2020-09-28
1992312631 Agnieszka Wanda Bis Occupational Therapy Assistant 110 W Schaumburg Rd, Streamwood, IL 60107-1459 2020-09-27
1093322091 Aven Dones Occupational Therapy Assistant 2600 W Compass Dr, Glenview, IL 60026 2020-09-24
1326651894 Laverne Reese Occupational Therapy Assistant 150 S Durkin Dr Apt, Springfield, IL 62704-1151 2020-08-25
1326650235 Cheryl Annette Perrilles Occupational Therapy Assistant 5124 S Alaska Rd, Peoria, IL 61607-9541 2020-08-21
1003426487 Allyx Underwood Occupational Therapy Assistant 111 S Homer St, Princeton, IL 61356-1850 2020-07-31
1023635364 Crystal Mary Dirks Occupational Therapy Assistant 211 75th St, Burr Ridge, IL 60527 2020-07-02
1508483991 Latika Kemp Occupational Therapy Assistant 7246 S. King Dr., Chicago, IL 60619-1726 2020-07-01
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City CARROLLTON
Zip Code 62016

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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