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General NPI Number Information
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NPI Number | 1770229445
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Entity Type | Organization
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Legal Business Name | REFLECTIONS DME BOUTIQUE
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Dates
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Enumeration Date | 05/06/2022
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Last Update Date | 05/06/2022
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Provider Practice Location Address
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Address Line | 254 REPUBLIC AVE
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City | JOLIET
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State | IL
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Zip | 60435-6518
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Country | US
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Telephone | 815-730-3344
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Fax | 815-730-3888
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Provider Business Mailing Address
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Address Line | 254 REPUBLIC AVE
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City | JOLIET
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State | IL
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Zip | 60435-6518
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Country | US
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Telephone | 815-730-3344
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Fax | 815-730-3888
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Authorized Official
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Title or Position | VICE PRESIDENT OF OPERATIONS
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Name | MRS. LORI A RUSS
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Credential |
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Telephone | 815-730-3344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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