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General NPI Number Information
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NPI Number | 1548715402
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Entity Type | Organization
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Legal Business Name | SPECIALTY REHAB & WELLNESS
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Dates
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Enumeration Date | 08/22/2016
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Last Update Date | 08/22/2016
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Provider Practice Location Address
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Address Line | 3309 CRYSTAL LAKE DR FESTUS
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City | FESTUS
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State | MO
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Zip | 63028-4274
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Country | US
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Telephone | 314-313-1088
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Fax |
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Provider Business Mailing Address
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Address Line | 3309 CRYSTAL LAKE DR FESTUS
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City | FESTUS
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State | MO
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Zip | 63028-4274
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Country | US
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Telephone | 314-313-1088
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Fax |
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Authorized Official
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Title or Position | OWNER/OCCUPATIONAL THERAPIST
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Name | SHELLY L BLANKENSHIP
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Credential | MS, OTR/L, CLT
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Telephone | 314-313-1088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 2000175372
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License Number State | MO
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