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NPI Code Detail

MEDICARE: LUMIERE CHILDREN'S THERAPY, LLC

MEDICARE: LUMIERE CHILDREN'S THERAPY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker
2103K00000XBehavior Analyst
32251P0200XPediatric Physical Therapist
4225XP0200XPediatric Occupational Therapist
5235Z00000XSpeech-Language Pathologist
6252Y00000XEarly Intervention Provider Agency
72080P0006XDevelopmental - Behavioral Pediatrics Physician

General Provider Information

NPI Number : 1497054050
Entity Type Code : Organization
Provider Name (Legal Business Name) : LUMIERE CHILDREN'S THERAPY, LLC
Provider Business Mailing Address
First Line : 1500 N CLYBOURN AVE UNIT C105
Second Line :
City : CHICAGO
State : IL
Zip : 60610-2295
Country : US
Telephone Number : 773-206-7997
Fax Number : 888-972-7531
Provider Business Practice Location Address
First Line : 1500 N CLYBOURN AVE UNIT C105
Second Line :
City : CHICAGO
State : IL
Zip : 60610-2295
Country : US
Telephone Number : 312-242-1665
Fax Number : 888-972-7531
Authorized Official
Title or Position : OWNER/EXECUTIVE DIRECTOR
Name : MS. VASILIKITSA ANTONOPOULOS
Credential : M.A. CCC-SLP/L
Telephone Number : 773-206-7997
Provider Enumeration Date : 03/22/2011
Last Update Date : 01/18/2022

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