1477877637 NPI number — INNOVATIVE REHABILITATION SERVICES

Table of content: STEPHANIE DEFEO HALL APRN (NPI 1649957606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477877637 NPI number — INNOVATIVE REHABILITATION SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNOVATIVE REHABILITATION SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1477877637
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2351 SOLOMON AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BILLINGS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-656-3042
Provider Business Mailing Address Fax Number:
406-651-1589

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2351 SOLOMON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BILLINGS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59102-2879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-656-3042
Provider Business Practice Location Address Fax Number:
406-651-1589
Provider Enumeration Date:
03/17/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PETROWITZ
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OCCUPATIONAL THERAPY ASSISTANT
Authorized Official Telephone Number:
406-248-7201

Provider Taxonomy Codes

  • Taxonomy code: 224Z00000X , with the licence number:  124 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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