Provider Demographics
NPI:1528404126
Name:IREHAB
Entity Type:Organization
Organization Name:IREHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DWAYNE
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:251-408-7779
Mailing Address - Street 1:8826 LAKE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-6939
Mailing Address - Country:US
Mailing Address - Phone:251-408-7779
Mailing Address - Fax:251-408-7779
Practice Address - Street 1:22873 US HWY 98
Practice Address - Street 2:BUILDING I SUITE 5
Practice Address - City:MONTROSE
Practice Address - State:AL
Practice Address - Zip Code:36559
Practice Address - Country:US
Practice Address - Phone:251-408-7779
Practice Address - Fax:251-408-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1265225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty