Healthcare Provider Details

I. General information

NPI: 1235288119
Provider Name (Legal Business Name): PREVENTION WORK, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 04/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 REDONDO DR
ROMEOVILLE IL
60446-3705
US

IV. Provider business mailing address

23005 S KENT RD
CHANNAHON IL
60410-3019
US

V. Phone/Fax

Practice location:
  • Phone: 815-886-5982
  • Fax: 815-886-5983
Mailing address:
  • Phone: 815-467-3831
  • Fax: 815-467-3989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.003158
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number057000054
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number870002850
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160000783
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License Number0560000256
License Number StateIL
# 6
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056000256
License Number StateIN

VIII. Authorized Official

Name: MS. TERRY ROAT
Title or Position: PRESIDENT
Credential: OTR
Phone: 630-548-2520