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General NPI Number Information
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NPI Number | 1841728474
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Entity Type | Organization
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Legal Business Name | SKILL BUILDERS THERAPY LLC
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Dates
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Enumeration Date | 05/26/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1023 US HIGHWAY 45
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City | FAIRFIELD
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State | IL
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Zip | 62837-2909
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Country | US
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Telephone | 618-895-4260
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Fax | 618-551-8835
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Provider Business Mailing Address
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Address Line | 1023 US HIGHWAY 45
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City | FAIRFIELD
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State | IL
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Zip | 62837-2909
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Country | US
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Telephone | 618-895-4260
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Fax | 618-551-8835
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Authorized Official
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Title or Position | MANAGER
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Name | DEANA LYNNE HOSTETTLER
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Credential | MSOTR/L
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Telephone | 618-895-4260
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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 |
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License Number State | IL
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