Individual
KIMBERLY DAWN RUBENACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
4121 VETERANS MEMORIAL DR, MOUNT VERNON, IL 62864-6262
(618) 242-3778
(618) 242-2551
Mailing address
4121 VETERANS MEMORIAL DR, MOUNT VERNON, IL 62864-6262
(618) 242-3778
(618) 242-2551
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056006678
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056006678
STATE LICENSE
IL
Enumeration date
05/20/2006
Last updated
03/16/2010
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