Organization
HERBOTH DEVELOPMENTAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLY HERBOTH (OWNER)
(618) 322-5493
Entity
Organization
Contact information
Practice address
2868 E 825TH AVE, ALTAMONT, IL 62411-3554
(618) 322-5493
(217) 280-4261
Mailing address
2868 E 825TH AVE, ALTAMONT, IL 62411-3554
(618) 322-5493
(217) 280-4261
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Enumeration date
06/07/2019
Last updated
06/07/2019
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