Shelly Rae Herboth
Individual provider Active NPI Developmental Therapist · Altamont, IL
NPI 1386941292 · NPPES record last updated Feb 13, 2011
Key facts
- NPI
- 1386941292
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Developmental Therapist 222Q00000X
- Practice address
- 2868 E 825TH Ave
Altamont, IL 62411-3554 - Phone
- (618) 483-5493
- NPI assigned
- Feb 13, 2011
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | Yes |
Addresses
Primary practice location
2868 E 825TH Ave
Altamont, IL 62411-3554
Mailing address
2868 E 825TH Ave
Altamont, IL 62411-3554
Phone (618) 483-5493
Other providers in Altamont, IL
- Kory M Flood
- Heather Lynn Forys
- Robert W Frost
- Jon Richmond Gieseking
- Herboth Developmental Therapy
- Mindy Hoedebecke
- HSHS Medical Group Inc
- Jon Richmond Gieseking
- Kathryn Lynn Koester
- Kremer Pharmacy Inc.
All providers in Altamont, IL · Developmental Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 13, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.