Provider Demographics
NPI:1942849666
Name:HORRELL, NATALIE MARIE
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:MARIE
Last Name:HORRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10161 PINE CREST RD
Mailing Address - Street 2:
Mailing Address - City:RED BUD
Mailing Address - State:IL
Mailing Address - Zip Code:62278-4458
Mailing Address - Country:US
Mailing Address - Phone:618-615-8843
Mailing Address - Fax:
Practice Address - Street 1:10161 PINE CREST RD
Practice Address - Street 2:
Practice Address - City:RED BUD
Practice Address - State:IL
Practice Address - Zip Code:62278-4458
Practice Address - Country:US
Practice Address - Phone:618-615-8843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057005324224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant