Provider Demographics
NPI:1548306053
Name:WETHERILL, JONAH B (OTR L)
Entity type:Individual
Prefix:
First Name:JONAH
Middle Name:B
Last Name:WETHERILL
Suffix:
Gender:M
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W ALGONQUIN RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4439
Mailing Address - Country:US
Mailing Address - Phone:847-956-0388
Mailing Address - Fax:847-956-0379
Practice Address - Street 1:515 W ALGONQUIN RD
Practice Address - Street 2:SUITE 120
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4439
Practice Address - Country:US
Practice Address - Phone:847-956-0388
Practice Address - Fax:847-956-0379
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK19026Medicare PIN
ILK19025Medicare PIN