Organization
BREAKTHROUGH PEDIATRIC THERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER STUBBLEFIELD (OTR/L)
(618) 218-2653
Entity
Organization
Contact information
Practice address
13030 GULLEY LN, BENTON, IL 62812-4110
(618) 218-2653
Mailing address
13030 GULLEY LN, BENTON, IL 62812-4110
(618) 218-2653
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Enumeration date
04/09/2021
Last updated
04/09/2021
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