Healthcare Provider Details

I. General information

NPI: 1790814739
Provider Name (Legal Business Name): THERAPEUTIC SOLUTIONS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 APRIL AVE
CARMI IL
62821-1577
US

IV. Provider business mailing address

108 APRIL AVE
CARMI IL
62821-1577
US

V. Phone/Fax

Practice location:
  • Phone: 618-382-3755
  • Fax:
Mailing address:
  • Phone: 618-382-3755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name: COURTNEY LYNNE NEAL
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR
Phone: 618-382-3755