Provider Demographics
NPI:1275944175
Name:POETTKER PEDIATRIC THERAPY SERVICES, P.C
Entity Type:Organization
Organization Name:POETTKER PEDIATRIC THERAPY SERVICES, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THEARPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:NEELY
Authorized Official - Middle Name:REANNA
Authorized Official - Last Name:POETTKER
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR/L
Authorized Official - Phone:618-401-3210
Mailing Address - Street 1:14163 JEM DR
Mailing Address - Street 2:
Mailing Address - City:AVISTON
Mailing Address - State:IL
Mailing Address - Zip Code:62216-3646
Mailing Address - Country:US
Mailing Address - Phone:618-228-7229
Mailing Address - Fax:618-228-7229
Practice Address - Street 1:14163 JEM DR
Practice Address - Street 2:
Practice Address - City:AVISTON
Practice Address - State:IL
Practice Address - Zip Code:62216-3646
Practice Address - Country:US
Practice Address - Phone:618-228-7229
Practice Address - Fax:618-228-7229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2013002846225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty