Healthcare Provider Details

I. General information

NPI: 1679631790
Provider Name (Legal Business Name): CHILDRENS THERAPY SPECIALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10257 W LINCOLN HIGHWAY
FRANKFORT IL
60423
US

IV. Provider business mailing address

10257 W LINCOLN HIGHWAY
FRANKFORT IL
60423
US

V. Phone/Fax

Practice location:
  • Phone: 815-469-1117
  • Fax: 815-469-1103
Mailing address:
  • Phone: 815-469-1117
  • Fax: 815-469-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHARI S CASSIDY
Title or Position: SECRETARY
Credential: PT
Phone: 815-469-1117