Provider Demographics
NPI:1528174422
Name:HOUGHTON, NANCY J (OT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:HOUGHTON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:J
Other - Last Name:WHITBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L, CHT
Mailing Address - Street 1:5003 HONONEGAH RD
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-8645
Mailing Address - Country:US
Mailing Address - Phone:815-623-3700
Mailing Address - Fax:815-623-3737
Practice Address - Street 1:5003 HONONEGAH RD
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-8645
Practice Address - Country:US
Practice Address - Phone:815-623-3700
Practice Address - Fax:815-623-3737
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-005170225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6503330001Medicare NSC
ILK36393Medicare PIN