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Organization
SOUTHERN REHAB SPECIALISTS, LLC
Active
Organization
SOUTHERN REHAB SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH RENEE SURPRENANT OTR/L (OWNER, OCCUPATIONAL THERAPIST)
(618) 559-5610
Entity
Organization
Contact information
Practice address
3216 MUSTANG CT, HERRIN, IL 62948-3783
(618) 559-5610
Mailing address
3216 MUSTANG CT, HERRIN, IL 62948-3783
(618) 559-5610
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056.007020
IL
235Z00000X
Speech-Language Pathologist
146.009800
IL
Other
Enumeration date
07/17/2012
Last updated
07/17/2012
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