Provider Demographics
NPI:1780274225
Name:VEDDER-REID, AMBER LEANN (OTR)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LEANN
Last Name:VEDDER-REID
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:SAVOY
Mailing Address - State:IL
Mailing Address - Zip Code:61874-9596
Mailing Address - Country:US
Mailing Address - Phone:217-841-4460
Mailing Address - Fax:
Practice Address - Street 1:3222 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-7919
Practice Address - Country:US
Practice Address - Phone:217-431-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.013877225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist