Provider Demographics
NPI:1508618802
Name:INSPIRE THERAPY OF SOUTHERN ILLINOIS LLC
Entity Type:Organization
Organization Name:INSPIRE THERAPY OF SOUTHERN ILLINOIS LLC
Other - Org Name:INSPIRE THERAPY OF SOUTHERN ILLINOIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST-REGISTERED
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:618-746-9209
Mailing Address - Street 1:1200 ANISE CT
Mailing Address - Street 2:
Mailing Address - City:FREEBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62243-2118
Mailing Address - Country:US
Mailing Address - Phone:618-746-9209
Mailing Address - Fax:
Practice Address - Street 1:1200 ANISE CT
Practice Address - Street 2:
Practice Address - City:FREEBURG
Practice Address - State:IL
Practice Address - Zip Code:62243-2118
Practice Address - Country:US
Practice Address - Phone:618-746-9209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty