Provider Demographics
NPI:1841728474
Name:SKILL BUILDERS THERAPY LLC
Entity type:Organization
Organization Name:SKILL BUILDERS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:HOSTETTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSOTR/L
Authorized Official - Phone:618-895-4260
Mailing Address - Street 1:1023 US HIGHWAY 45
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62837-2909
Mailing Address - Country:US
Mailing Address - Phone:618-895-4260
Mailing Address - Fax:618-551-8835
Practice Address - Street 1:1023 US HIGHWAY 45
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IL
Practice Address - Zip Code:62837-2909
Practice Address - Country:US
Practice Address - Phone:618-895-4260
Practice Address - Fax:618-551-8835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL332727850001Medicaid