| NPI | 1447865399 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KILEY RUSSELL Director 773-966-5039 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics |
| Additional Taxonomies | 251S00000X |
| 252Y00000X Early Intervention Provider Agency | |
| 253Z00000X In Home Supportive Care | |
| 261QH0700X Clinic/Center, Hearing and Speech | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QP2000X Clinic/Center, Physical Therapy | |
| Enumeration Date | 2020-09-08 |
| Last Update Date | 2020-09-08 |