Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Voluntary or Charitable |
251V00000X | 61 | Voluntary Health or Charitable Agency[1] | |
Occupational Therapist |
225X00000X | 67 | Occupational Therapist in Private Practice | |
Pediatric Rehabilitation Medicine |
2081P0010X | 25 | Physician/Physical Medicine and Rehabilitation | |
Speech-Language Pathologist |
235Z00000X | 15 | Speech Language Pathologist |
| NPI # | 1063544401 |
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| LBN Legal business name | STARVED ROCK REGIONAL CENTER FOR THERAPY & CHILD DEVELOPMENT | ||||
| Authorized official | PAULA WILLIAMSON - (PROGRAM DIRECTOR) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 03/12/2007 | ||||
| Last updated | 06/19/2018 - About 8 years ago | ||||
| Identifiers |
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