=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881059806
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | METRO EAST THERAPY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2015
-----------------------------------------------------
Last Update Date | 01/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 60 S STATE ROUTE 157 STE 20
-----------------------------------------------------
City | EDWARDSVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62025-3899
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-581-8304
-----------------------------------------------------
Fax | 618-307-6787
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 60 S STATE ROUTE 157 STE 20
-----------------------------------------------------
City | EDWARDSVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62025-3899
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-581-8304
-----------------------------------------------------
Fax | 618-307-6787
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARGARET SCHONAUER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 618-581-8304
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 146011286
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------