| NPI | 1689792822 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MYLENE BRAGGS Member 708-715-2555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: IL 056.004242) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: IL 146.004828) |
| 101YP2500X Counselor, Professional (Licence: IL 180.005672) | |
| 2251P0200X Physical Therapist, Pediatrics (Licence: IL 070.016938) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2021-02-22 |