MEDICARE: PLAYTIME DEVELOPMENTAL THERAPY

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
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1548659154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAYTIME DEVELOPMENTAL THERAPY

Provider Business Mailing Address
First Line	:	2121 W THOMAS ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-3629
Country	:	US
Telephone Number	:	847-347-4445
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 W THOMAS ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-3629
Country	:	US
Telephone Number	:	847-347-4445
Fax Number	:

Authorized Official
Title or Position	:	DEVELOPMENTAL THERAPIST
Name	:	LAUREN STERN
Credential	:	D.T.
Telephone Number	:	847-347-4445

Provider Enumeration Date	:	01/20/2015
Last Update Date	:	01/20/2015

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