MEDICARE: LITTLE ONES PEDIATRIC 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
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1932796380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE ONES PEDIATRIC THERAPY LLC

Provider Business Mailing Address
First Line	:	1520 MAPLE AVE
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-5475
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 MAPLE AVE
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-5475
Country	:	US
Telephone Number	:	847-400-7860
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JULIE STOCKING
Credential	:	MOT, OTR/L
Telephone Number	:	847-400-7860

Provider Enumeration Date	:	12/30/2020
Last Update Date	:	12/30/2020

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