Healthcare Provider Details

I. General information

NPI: 1609184704
Provider Name (Legal Business Name): CONNECT THE DOTS THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 S WATER ST UNIT B
BATAVIA IL
60510-2447
US

IV. Provider business mailing address

PO BOX 153
BATAVIA IL
60510-0153
US

V. Phone/Fax

Practice location:
  • Phone: 630-399-2244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056006476
License Number StateIL

VIII. Authorized Official

Name: MRS. CARRIE KRANZ
Title or Position: OTR/L
Credential:
Phone: 630-399-2244