Provider Demographics
NPI:1376648220
Name:INJURY REHABILITATION CLINIC II, INC.
Entity Type:Organization
Organization Name:INJURY REHABILITATION CLINIC II, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OTR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:262-781-8144
Mailing Address - Street 1:3415 N 127TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-3117
Mailing Address - Country:US
Mailing Address - Phone:262-781-8144
Mailing Address - Fax:262-781-8552
Practice Address - Street 1:3415 N 127TH ST
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-3117
Practice Address - Country:US
Practice Address - Phone:262-781-8144
Practice Address - Fax:262-781-8552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI892-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty