Ethan Ridenour is a Carrollton, Illinois based therapist who is specialized in Occupational Therapy. Active license number of Ethan Ridenour is 057004022 for Occupational Therapy in Illinois. His current practice location is 320 4th Street, Carrollton. Patients can reach him at 314-328-9362 or can fax him at 618-619-6881. Ethan Ridenour is COTA/L in Occupational Therapy and his NPI number (Unique professional ID assigned by NPPES) is 1912319039.
Ethan Ridenour address the physical, cognitive, psychosocial, sensory, and other aspects of occupational performance in a variety of contexts to support engagement in everyday life activities that affect health, well-being, and quality of life.
Complete Profile:
Ethan Ridenour speciality, credentials, practice address, contact phone number and fax are as below.
Patients can call on the below given phone number for appointment.
| Name: | Ethan Ridenour |
| Specialization: | Occupational Therapy |
| Gender: | Male |
| Credentials: | COTA/L |
| Practice Address: | 320 4th Street, Carrollton,
Illinois, 62016-1135 |
| Phone: | 314-328-9362 |
| Fax: | 618-619-6881 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details are as mentioned below.
| NPI Number: | 1912319039 |
| NPI Enumeration Date: | 22 May, 2014 |
| NPI Last Update On: | 15 Oct, 2018 |
Medical Licenses:
Doctors can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Ethan Ridenour are as mentioned below.
| License Number | Specialization | State | Status | |
| 057004022 | Occupational Therapy | Illinois | Primary | |
| 057001592 | Occupational Therapy Assistant | Illinois | Secondary | |
| 056004047 | Occupational Therapy | Illinois | Secondary | |
| 146010465 | Speech-Language Pathologist | Illinois | Secondary | |
Other Medical Identifiers:
Other legacy medical identifiers associated with Ethan Ridenour such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
| Identifier | Type | State | Issuer |
| 1912319039 | Other | Illinois | MEDICARE |
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | Ethan Ridenour
320 4th Street,
Carrollton, Illinois |
| Zip: | 62016-1135 |
| Phone Number: | 314-328-9362 |
| Fax Number: | 618-619-6881 |
Patients can reach Ethan Ridenour at
320 4th Street, Carrollton, Illinois or can
call to book an appointment on 314-328-9362.
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Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 09 March, 2026.