1366658908 NPI number — MRS. TANYA RHEA KESSINGER MS, OTRL

Table of content: MRS. TANYA RHEA KESSINGER MS, OTRL (NPI 1366658908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366658908 NPI number — MRS. TANYA RHEA KESSINGER MS, OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KESSINGER
Provider First Name:
TANYA
Provider Middle Name:
RHEA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, OTRL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366658908
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24654 ROUTE 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLINVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62626-3679
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-556-6299
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
912 MORGAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLINVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62626-1425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-854-3141
Provider Business Practice Location Address Fax Number:
217-854-9820
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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