Healthcare Provider Details

I. General information

NPI: 1003635350
Provider Name (Legal Business Name): PLAYFUL PEDIATRIC THERAPIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5541 WASHINGTON ST
DOWNERS GROVE IL
60516-1328
US

IV. Provider business mailing address

5541 WASHINGTON ST
DOWNERS GROVE IL
60516-1328
US

V. Phone/Fax

Practice location:
  • Phone: 630-776-0137
  • Fax:
Mailing address:
  • Phone: 630-776-0137
  • 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 Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. JILLIAN MALLEN
Title or Position: OCCUPATIONAL THERAPIST/OWNER
Credential: MS, OTR/L
Phone: 630-776-0137