Healthcare Provider Details

I. General information

NPI: 1497167019
Provider Name (Legal Business Name): SARAH BUHNERKEMPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 18TH ST
CHARLESTON IL
61920-2382
US

IV. Provider business mailing address

680 S 4TH ST
LOUISVILLE KY
40202-2407
US

V. Phone/Fax

Practice location:
  • Phone: 217-345-7054
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056009829
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: