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General NPI Number Information
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NPI Number | 1124796222
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Entity Type | Organization
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Legal Business Name | ENVISION INDEPENDENCE REHAB SERVICES LLC
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Dates
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Enumeration Date | 09/02/2021
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Last Update Date | 09/02/2021
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Provider Practice Location Address
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Address Line | 108 BUTTERCUP DR
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City | CRANBERRY TWP
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State | PA
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Zip | 16066-6314
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Country | US
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Telephone | 724-900-4633
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Fax |
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Provider Business Mailing Address
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Address Line | 108 BUTTERCUP DR
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City | CRANBERRY TWP
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State | PA
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Zip | 16066-6314
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Country | US
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Telephone | 724-900-4633
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Fax |
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Authorized Official
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Title or Position | OWNER AND DIRECTOR
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Name | GEORGIANN DIETEMAN
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Credential | OT
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Telephone | 724-900-4633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XL0004X
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Taxonomy Name | Low Vision Occupational Therapist
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License Number |
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License Number State |
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