Healthcare Provider Details

I. General information

NPI: 1588864888
Provider Name (Legal Business Name): NOVACARE REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 RICKER RD
SALEM IL
62881-4263
US

IV. Provider business mailing address

1201 RICKER RD
SALEM IL
62881-4263
US

V. Phone/Fax

Practice location:
  • Phone: 618-548-3194
  • Fax: 618-548-4902
Mailing address:
  • Phone: 618-548-3194
  • Fax: 618-548-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. KERI ANN PAULSON
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 618-548-3194