MEDICARE: CHANNELS REHABILITATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1235883711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANNELS REHABILITATION LLC

Provider Business Mailing Address
First Line	:	109 N 2ND AVE STE 203
Second Line	:
City	:	ALPENA
State	:	MI
Zip	:	49707-5305
Country	:	US
Telephone Number	:	989-278-8747
Fax Number	:	989-331-6705

Provider Business Practice Location Address
First Line	:	109 N 2ND AVE STE 203
Second Line	:
City	:	ALPENA
State	:	MI
Zip	:	49707-5305
Country	:	US
Telephone Number	:	989-278-8747
Fax Number	:	989-331-6705

Authorized Official
Title or Position	:	OWNER, SPEECH-LANGUAGE PATHOLOGIST
Name	:	DEVON AMANDA IDALSKI
Credential	:	MS CCC-SLP
Telephone Number	:	810-305-0627

Provider Enumeration Date	:	02/04/2022
Last Update Date	:	12/07/2022

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Directions to “CHANNELS REHABILITATION LLC ” Practice Location

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