Provider Demographics
NPI:1659066280
Name:WINTER, PAIGE (OTR/L)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:WINTER
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 1:1146 COUNTY ROAD 1500 E
Mailing Address - Street 2:
Mailing Address - City:CARMI
Mailing Address - State:IL
Mailing Address - Zip Code:62821-5225
Mailing Address - Country:US
Mailing Address - Phone:618-384-0424
Mailing Address - Fax:
Practice Address - Street 1:108 APRIL AVE
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-1577
Practice Address - Country:US
Practice Address - Phone:618-382-2771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056015388225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist