Healthcare Provider Details

I. General information

NPI: 1174993901
Provider Name (Legal Business Name): RIVER CITY REHAB & VOCATIONAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 DEWEY ST #4
WHEELERSBURG OH
45694-1757
US

IV. Provider business mailing address

PO BOX 251
WHEELERSBURG OH
45694-0251
US

V. Phone/Fax

Practice location:
  • Phone: 740-935-0685
  • Fax: 740-981-3173
Mailing address:
  • Phone: 740-935-0685
  • Fax: 740-981-3173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberR0952
License Number StateKY

VIII. Authorized Official

Name: MS. CINDY NEWSOM
Title or Position: OWNER - OCCUPATIONAL THERAPIST
Credential: OT
Phone: 740-935-0685