Search › Illinois › 224Z00000X
Ethan Ridenour, COTA/L
NPI 1912319039 · on the registry since 2014
Practice
- Address
- 320 4th Street
Carrollton, IL 62016 - Phone
- (314) 328-9362
- Fax
- (618) 619-6881
Additional practice sites
- 610 Lowry St, Pittsfield, IL
Registry record
- Primary taxonomy
- 224Z00000X
224Z00000X
- Also registered as
- 224Z00000X
225X00000X
235Z00000X - Licence states on file
- IL
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2018-10-15
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois