Provider Demographics
NPI:1043104821
Name:CARDINAL REHAB
Entity type:Organization
Organization Name:CARDINAL REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:330-936-3091
Mailing Address - Street 1:24 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654-1464
Mailing Address - Country:US
Mailing Address - Phone:330-936-3091
Mailing Address - Fax:
Practice Address - Street 1:2637 TUSKY VALLEY RD NE
Practice Address - Street 2:
Practice Address - City:ZOARVILLE
Practice Address - State:OH
Practice Address - Zip Code:44656-9692
Practice Address - Country:US
Practice Address - Phone:330-866-0303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center