Basic Information
| Provider Information | |||||||||
| NPI: | 1952795676 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REDPATH | ||||||||
| FirstName: | JOSEE | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 HAWTHORN RD | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185484884 | ||||||||
| FaxNumber: | 6185482150 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 HAWTHORN RD | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628811028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185484884 | ||||||||
| FaxNumber: | 6185482150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2015 | ||||||||
| LastUpdateDate: | 03/19/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 056010455 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.