Provider Demographics
NPI:1003657966
Name:TWOMBLY, CELESTE VAUGHN
Entity type:Individual
Prefix:MISS
First Name:CELESTE
Middle Name:VAUGHN
Last Name:TWOMBLY
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 1:1703 N BROOK CT
Mailing Address - Street 2:
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-3743
Mailing Address - Country:US
Mailing Address - Phone:217-722-6160
Mailing Address - Fax:
Practice Address - Street 1:1123 GREENLEAF AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2708
Practice Address - Country:US
Practice Address - Phone:847-610-9585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.016011225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist