Provider Demographics
NPI:1689746216
Name:OCCUPATIONAL PERFORMANCE AND REHAB, PC
Entity Type:Organization
Organization Name:OCCUPATIONAL PERFORMANCE AND REHAB, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VERLINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, MS, OTR/L
Authorized Official - Phone:618-993-6237
Mailing Address - Street 1:3905 W ERNESTINE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5800
Mailing Address - Country:US
Mailing Address - Phone:618-993-6237
Mailing Address - Fax:618-997-3529
Practice Address - Street 1:3905 W ERNESTINE DR
Practice Address - Street 2:SUITE B
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5800
Practice Address - Country:US
Practice Address - Phone:618-993-6237
Practice Address - Fax:618-997-3529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013687225100000X
IL070001021225100000X
IL070015812225100000X
IL056.003255225X00000X
IL056006919225X00000X
IL056007020225X00000X
IL056006921225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6062120001Medicare NSC
IL213485Medicare ID - Type UnspecifiedGROUP MEDICARE PT
IL213486Medicare ID - Type UnspecifiedGROUP MEDICARE OT