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General NPI Number Information
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NPI Number | 1104044627
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Entity Type | Organization
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Legal Business Name | NEUROREHAB, L.L.C.
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Dates
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Enumeration Date | 04/22/2007
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Last Update Date | 12/09/2010
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Provider Practice Location Address
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Address Line | 1 E CAMPUS VIEW BLVD SUITE 220
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City | COLUMBUS
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State | OH
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Zip | 43235-5691
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Country | US
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Telephone | 614-847-9008
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Fax |
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Provider Business Mailing Address
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Address Line | 1 E CAMPUS VIEW BLVD SUITE 220
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City | COLUMBUS
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State | OH
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Zip | 43235-5691
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Country | US
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Telephone | 614-847-9008
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. MARY HILL
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Credential | PH.D.
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Telephone | 614-847-9008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 5490
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 5490
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number | 5490
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 5490
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License Number State | OH
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