Basic Information
| Provider Information | |||||||||
| NPI: | 1710465257 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERSCHBACHER | ||||||||
| FirstName: | STEVE | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3704 CARLYLE AVE | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622217407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186238087 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1405 N 2ND ST | ||||||||
| Address2: | |||||||||
| City: | SWANSEA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622264213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182336625 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2018 | ||||||||
| LastUpdateDate: | 08/06/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 057001988 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.