Healthcare Provider Details

I. General information

NPI: 1083312672
Provider Name (Legal Business Name): SNAP THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10815 S FAIRFIELD AVE
CHICAGO IL
60655-1722
US

IV. Provider business mailing address

10815 S FAIRFIELD AVE
CHICAGO IL
60655-1722
US

V. Phone/Fax

Practice location:
  • Phone: 708-369-8494
  • 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

VIII. Authorized Official

Name: LAUREN FASAN
Title or Position: MEMBER
Credential:
Phone: 708-369-8494