Healthcare Provider Details

I. General information

NPI: 1285761007
Provider Name (Legal Business Name): SARAH PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19100 CRESANT DRIVE
MOKENA IL
60448
US

IV. Provider business mailing address

8122 W SAUK TRL
FRANKFORT IL
60423-9785
US

V. Phone/Fax

Practice location:
  • Phone: 708-478-5400
  • Fax:
Mailing address:
  • Phone: 815-464-4603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number05606548
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: