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General NPI Number Information
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NPI Number | 1063544401
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Entity Type | Organization
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Legal Business Name | STARVED ROCK REGIONAL CENTER FOR THERAPY & CHILD DEVELOPMENT
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 06/19/2018
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Provider Practice Location Address
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Address Line | 1013 ADAMS STREET
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City | OTTAWA
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State | IL
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Zip | 61354-4304
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Country | US
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Telephone | 815-434-0857
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Fax | 815-434-2260
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Provider Business Mailing Address
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Address Line | 1013 ADAMS STREET
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City | OTTAWA
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State | IL
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Zip | 61354-4304
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Country | US
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Telephone | 815-434-0857
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Fax | 815-434-2260
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MRS. PAULA SUE WILLIAMSON
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Credential |
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Telephone | 815-434-0857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P0010X
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Taxonomy Name | Pediatric Rehabilitation Medicine Physician
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State | IL
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