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General NPI Number Information
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NPI Number | 1811015548
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Entity Type | Organization
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Legal Business Name | IN HOME REHAB OF DICKINSON COUNTY
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | N19748 TIMM'S LAKE ROAD SUITE 1
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City | NIAGARA
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State | WI
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Zip | 54151
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Country | US
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Telephone | 906-563-8920
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Fax |
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Provider Business Mailing Address
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Address Line | W3101 RIDGECREST RD.
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City | VULCAN
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State | MI
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Zip | 49892
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Country | US
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Telephone | 906-563-8920
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHERYL L CARLSON
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Credential |
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Telephone | 906-563-8920
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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 | 5201002404
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501003532
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License Number State | MI
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