Healthcare Provider Details

I. General information

NPI: 1548771181
Provider Name (Legal Business Name): URBAN KIDS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11729 WOODSIDE CT
BURR RIDGE IL
60527-8050
US

IV. Provider business mailing address

11729 WOODSIDE CT
BURR RIDGE IL
60527-8050
US

V. Phone/Fax

Practice location:
  • Phone: 630-915-7022
  • Fax:
Mailing address:
  • Phone: 630-915-7022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056.008526
License Number StateIL

VIII. Authorized Official

Name: ANNE URBAN
Title or Position: OCCUPATIONAL THERAPIST
Credential: MS, OTR/L
Phone: 630-915-7022