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General NPI Number Information
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NPI Number | 1164088225
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Entity Type | Organization
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Legal Business Name | SKILLS 4 LIFE OT, LLC
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Dates
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Enumeration Date | 05/14/2019
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Last Update Date | 05/14/2019
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Provider Practice Location Address
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Address Line | 2020 BROADWAY ST APT 1
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City | MOUNT VERNON
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State | IL
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Zip | 62864-2963
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Country | US
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Telephone | 618-214-0371
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Fax |
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Provider Business Mailing Address
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Address Line | 43 WOODS LN
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City | CENTRALIA
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State | IL
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Zip | 62801-6239
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Country | US
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Telephone | 618-214-0371
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | NANCY A SIMMONS
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Credential | MHS, OTR/L
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Telephone | 618-214-0371
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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 |
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License Number State |
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