# SOUTHERN REHAB WORKS, LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205174638
- **Authorized official:** MRS. STEPHANIE MARIE LAMPORT MOT,OTR/L (OWNER)
- **Authorized official phone:** (618) 534-5670

## Contact information

- **Practice address:** 580 HOOT OWL LN, WOLF LAKE, IL 62998-1137
- **Practice address phone:** (618) 534-5670
- **Mailing address:** PO BOX 1652, MURPHYSBORO, IL 62966-5152
- **Mailing address phone:** (618) 534-5670

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0400X | Rehabilitation Clinic/Center | 056.008780 | IL | Yes |

## Other

- **Enumeration date:** 01/18/2013
- **Last updated:** 01/18/2013