Healthcare Provider Details

I. General information

NPI: 1083920789
Provider Name (Legal Business Name): THERAPY TOTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1157 W NEWPORT AVE UNIT C
CHICAGO IL
60657-1500
US

IV. Provider business mailing address

1157 W NEWPORT AVE UNIT C
CHICAGO IL
60657-1500
US

V. Phone/Fax

Practice location:
  • Phone: 773-549-6641
  • Fax:
Mailing address:
  • Phone: 773-549-6641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number056.004143
License Number StateIL

VIII. Authorized Official

Name: KRISTY A ZARLEY
Title or Position: OWNER
Credential:
Phone: 773-549-6641