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General NPI Number Information
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NPI Number | 1568586758
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Entity Type | Individual
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Provider Name | CHRIS STUBBLEFIELD OTR
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Gender | Male
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 130 LICK CREEK RD
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City | ANNA
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State | IL
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Zip | 62906-3270
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Country | US
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Telephone | 618-833-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 402 S POPLAR ST
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City | SESSER
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State | IL
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Zip | 62884-1710
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Country | US
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Telephone | 618-625-2311
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 056005576
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License Number State | IL
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