Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ethan Ridenour, COTA/L

Individual provider Occupational Therapy Assistant · NPI 1912319039

Ethan Ridenour, COTA/L is an Occupational Therapy Assistant in Carrollton, Illinois. Works from 2 locations. Licensed in Illinois.

Licensed in
IL
In the registry since
2014
Specialties on file
4
What do these letters mean?
COTA/L — Certified Occupational Therapy Assistant, Licensed
An occupational therapy assistant who is both certified and state licensed.

See every abbreviation used in this directory →

Practice location Address checks out

320 4th St
Carrollton, IL 62016-1135
Phone: (314) 328-9362
Fax: (618) 619-6881
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 610 Lowry St, Pittsfield, IL 62363-1768 — (217) 285-5200

Specialties & licences

Occupational Therapy Assistant (primary) Taxonomy 224Z00000X · Licence 057004022 (IL)
Occupational Therapy Assistant Taxonomy 224Z00000X · Licence 057001592 (IL)
Occupational Therapist Taxonomy 225X00000X · Licence 056004047 (IL)
Speech-Language Pathologist Taxonomy 235Z00000X · Licence 146010465 (IL)

Record details

NPI number1912319039
Entity typeIndividual (Type 1)
GenderMale
Credentials COTA/L
Sole proprietorNo
NPI enumeratedMay 22, 2014
Last updated in NPPESOctober 15, 2018