Provider Demographics
NPI:1164178950
Name:RESTORE REHAB LLC
Entity Type:Organization
Organization Name:RESTORE REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:T
Authorized Official - Last Name:BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CHT, CLT
Authorized Official - Phone:662-610-9181
Mailing Address - Street 1:1001 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-1323
Mailing Address - Country:US
Mailing Address - Phone:662-610-9181
Mailing Address - Fax:
Practice Address - Street 1:1001 VALLEY RD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-1323
Practice Address - Country:US
Practice Address - Phone:662-610-9181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty