MEDICARE: DPT HOLDINGS 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
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1588280903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DPT HOLDINGS LLC

Provider Business Mailing Address
First Line	:	2547 PLAINFIELD NAPERVILLE RD STE 152
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-8701
Country	:	US
Telephone Number	:	800-974-4378
Fax Number	:	630-515-1536

Provider Business Practice Location Address
First Line	:	75 EXECUTIVE DR STE 103
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-8150
Country	:	US
Telephone Number	:	800-974-4378
Fax Number	:	630-515-1536

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	CINDY SULLIVAN
Credential	:
Telephone Number	:	800-974-4378

Provider Enumeration Date	:	06/22/2020
Last Update Date	:	06/22/2020

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