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General NPI Number Information
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NPI Number | 1598217697
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Entity Type | Organization
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Legal Business Name | SOVEREIGN REHABILITATION OF ILLINOIS
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Dates
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Enumeration Date | 10/25/2016
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Last Update Date | 10/25/2016
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Provider Practice Location Address
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Address Line | 1315 MACOM DR SUITE 103
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City | NAPERVILLE
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State | IL
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Zip | 60564-9358
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Country | US
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Telephone | 630-585-7337
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Fax |
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Provider Business Mailing Address
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Address Line | 1315 MACOM DR SUITE 103
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City | NAPERVILLE
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State | IL
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Zip | 60564-9358
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Country | US
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Telephone | 630-585-7337
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PEDRIATRIC THERAPY
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Name | MRS. DENNIGER J DEBRA
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Credential | OTD
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Telephone | 630-585-7337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State | IL
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