Healthcare Provider Details

I. General information

NPI: 1316400278
Provider Name (Legal Business Name): BAMBINOS THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9834 S HAMLIN AVE
EVERGREEN PARK IL
60805-3363
US

IV. Provider business mailing address

9834 S HAMLIN AVE
EVERGREEN PARK IL
60805-3363
US

V. Phone/Fax

Practice location:
  • Phone: 708-921-2300
  • Fax:
Mailing address:
  • Phone: 708-921-2300
  • 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 Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. EMILY LYNN CONNOLLY
Title or Position: OCCUPATIONAL THERAPIST
Credential: MOTR/L
Phone: 708-921-2300