Provider Demographics
NPI:1326702424
Name:WHITFIELD, JONI MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:MARIE
Last Name:WHITFIELD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 HARVESTYME CT
Mailing Address - Street 2:
Mailing Address - City:BETHALTO
Mailing Address - State:IL
Mailing Address - Zip Code:62010-2529
Mailing Address - Country:US
Mailing Address - Phone:618-960-4267
Mailing Address - Fax:
Practice Address - Street 1:312 MECHANICAL DR
Practice Address - Street 2:
Practice Address - City:EAST ALTON
Practice Address - State:IL
Practice Address - Zip Code:62024-2008
Practice Address - Country:US
Practice Address - Phone:618-717-0820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056010280225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist