Provider Demographics
NPI:1326239492
Name:HUMPHREY, JOSHUA CHASE (OTR)
Entity Type:Individual
Prefix:PROF
First Name:JOSHUA
Middle Name:CHASE
Last Name:HUMPHREY
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17370 TIMBER DR
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-9281
Mailing Address - Country:US
Mailing Address - Phone:815-440-4596
Mailing Address - Fax:225-791-0095
Practice Address - Street 1:1201 1ST AVE
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:IL
Practice Address - Zip Code:61342-1815
Practice Address - Country:US
Practice Address - Phone:815-539-6745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.012055225X00000X
LAOTT.200092225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist