Healthcare Provider Details

I. General information

NPI: 1811015548
Provider Name (Legal Business Name): IN HOME REHAB OF DICKINSON COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N19748 TIMM'S LAKE ROAD SUITE 1
NIAGARA WI
54151
US

IV. Provider business mailing address

W3101 RIDGECREST RD.
VULCAN MI
49892
US

V. Phone/Fax

Practice location:
  • Phone: 906-563-8920
  • Fax:
Mailing address:
  • Phone: 906-563-8920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201002404
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501003532
License Number StateMI

VIII. Authorized Official

Name: CHERYL L CARLSON
Title or Position: OWNER
Credential:
Phone: 906-563-8920