Healthcare Provider Details

I. General information

NPI: 1770156994
Provider Name (Legal Business Name): PLAYFUL PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2021
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21201 S ELSNER RD UNIT 3
FRANKFORT IL
60423-4501
US

IV. Provider business mailing address

21201 S ELSNER RD
FRANKFORT IL
60423-4730
US

V. Phone/Fax

Practice location:
  • Phone: 708-805-0173
  • Fax: 708-694-7008
Mailing address:
  • Phone: 708-805-0173
  • Fax: 708-694-7008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARY KATHLEEN KUCHTA
Title or Position: OCCUPATIONAL THERAPIST
Credential: MS, OTR/L
Phone: 708-805-0173