Healthcare Provider Details

I. General information

NPI: 1518777564
Provider Name (Legal Business Name): SPOT 26 THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2025
Last Update Date: 01/11/2025
Certification Date: 01/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 WAUKEGAN ROAD PMB10038
BANNOCKBURN IL
60015
US

IV. Provider business mailing address

2515 WAUKEGAN ROAD PMB10038
BANNOCKBURN IL
60015
US

V. Phone/Fax

Practice location:
  • Phone: 847-275-5933
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: LINDSEY MARKS
Title or Position: OCCUPATIONAL THERAPIST, CO-OWNER
Credential: OTD, OTR/L
Phone: 847-275-5933