MEDICARE: MS. BRITTANY L PHILLIPS LBS1

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1952989907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRITTANY L PHILLIPS LBS1

Provider Business Mailing Address
First Line	:	14252 N SOUTH SHORE DR
Second Line	:
City	:	EFFINGHAM
State	:	IL
Zip	:	62401-6205
Country	:	US
Telephone Number	:	217-821-7087
Fax Number	:

Provider Business Practice Location Address
First Line	:	14252 N SOUTH SHORE DR
Second Line	:
City	:	EFFINGHAM
State	:	IL
Zip	:	62401-6205
Country	:	US
Telephone Number	:	217-821-7087
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2021
Last Update Date	:	03/31/2021

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