Provider Demographics
NPI:1033444377
Name:INNOVATIVE REHAB CONSULTANTS, INC.
Entity Type:Organization
Organization Name:INNOVATIVE REHAB CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VAN LIESHOUT
Authorized Official - Suffix:
Authorized Official - Credentials:MOTR, ATP
Authorized Official - Phone:920-674-6339
Mailing Address - Street 1:229 MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-1184
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:920-674-6345
Practice Address - Street 1:229 MEADOW CT
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-1184
Practice Address - Country:US
Practice Address - Phone:920-674-6339
Practice Address - Fax:920-674-6345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty