Basic Information
| Provider Information | |||||||||
| NPI: | 1528404126 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IREHAB | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8826 LAKE VIEW DR | ||||||||
| Address2: | |||||||||
| City: | FAIRHOPE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365326939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514087779 | ||||||||
| FaxNumber: | 2514087779 | ||||||||
| Practice Location | |||||||||
| Address1: | 22873 US HWY 98 | ||||||||
| Address2: | BUILDING I SUITE 5 | ||||||||
| City: | MONTROSE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514087779 | ||||||||
| FaxNumber: | 2514087779 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2013 | ||||||||
| LastUpdateDate: | 05/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | ABBOTT | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | DWAYNE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2514087779 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | OT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | 1265 | AL | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
No ID Information.