Provider Demographics
NPI:1346646957
Name:YODER, JOHN HENRY (COTA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HENRY
Last Name:YODER
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4833 COUNTY ROAD 79A
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:IN
Mailing Address - Zip Code:46721-9519
Mailing Address - Country:US
Mailing Address - Phone:260-385-5991
Mailing Address - Fax:
Practice Address - Street 1:4833 COUNTY ROAD 79A
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:IN
Practice Address - Zip Code:46721-9519
Practice Address - Country:US
Practice Address - Phone:260-385-5991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32002406A224Z00000X
AROT-A761224Z00000X
IL057.004148224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN32002406AOtherINDIANA STATE MEDICAL BOARD
IL057.004148OtherILLINOIS STATE MEDICAL BOARD
AROT-A761OtherARKANSAS STATE MEDICAL BOARD