Provider Demographics
NPI:1548220098
Name:YEAGER, NATHAN WAYNE (OT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:WAYNE
Last Name:YEAGER
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-1129
Mailing Address - Country:US
Mailing Address - Phone:217-391-4314
Mailing Address - Fax:
Practice Address - Street 1:901 W MORTON AVE
Practice Address - Street 2:SUITE 16A
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-3146
Practice Address - Country:US
Practice Address - Phone:217-245-4640
Practice Address - Fax:217-245-4642
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UNIV OF NORTH DAKOTAOtherSCHOOL