Provider Demographics
NPI:1063248482
Name:REARDON, FERN (OTA/L)
Entity type:Individual
Prefix:
First Name:FERN
Middle Name:
Last Name:REARDON
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:FERN
Other - Middle Name:
Other - Last Name:BUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTA/L
Mailing Address - Street 1:247 E DELWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-2512
Mailing Address - Country:US
Mailing Address - Phone:309-267-8541
Mailing Address - Fax:
Practice Address - Street 1:1200 E PARTRIDGE ST
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:IL
Practice Address - Zip Code:61548-9619
Practice Address - Country:US
Practice Address - Phone:309-367-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.003454224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant