Provider Demographics
NPI:1073737920
Name:SD REHAB INC.
Entity Type:Organization
Organization Name:SD REHAB INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:DAVIES
Authorized Official - Last Name:DEVLIN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR L
Authorized Official - Phone:773-477-7599
Mailing Address - Street 1:1962 N BISSELL ST
Mailing Address - Street 2:#2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5015
Mailing Address - Country:US
Mailing Address - Phone:773-477-7599
Mailing Address - Fax:733-477-7601
Practice Address - Street 1:1962 N BISSELL ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5015
Practice Address - Country:US
Practice Address - Phone:773-477-7599
Practice Address - Fax:773-477-7601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056003210225X00000X
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty