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General NPI Number Information
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NPI Number | 1073737920
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Entity Type | Organization
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Legal Business Name | SD REHAB INC.
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 06/29/2016
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Provider Practice Location Address
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Address Line | 1962 N BISSELL ST 2ND FLOOR
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City | CHICAGO
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State | IL
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Zip | 60614-5015
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Country | US
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Telephone | 773-477-7599
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Fax | 773-477-7601
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Provider Business Mailing Address
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Address Line | 1962 N BISSELL ST #2
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City | CHICAGO
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State | IL
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Zip | 60614-5015
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Country | US
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Telephone | 773-477-7599
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Fax | 733-477-7601
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. STEPHANIE DAVIES DEVLIN
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Credential | OTR L
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Telephone | 773-477-7599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056003210
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License Number State | IL
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