Healthcare Provider Details

I. General information

NPI: 1922450972
Provider Name (Legal Business Name): BFB THERAPEUTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 S MADISON AVE
LA GRANGE IL
60525-2801
US

IV. Provider business mailing address

504 S MADISON AVE
LA GRANGE IL
60525-2801
US

V. Phone/Fax

Practice location:
  • Phone: 708-917-9660
  • Fax: 708-469-7408
Mailing address:
  • Phone: 708-917-9660
  • Fax: 708-469-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056.002081
License Number StateIL

VIII. Authorized Official

Name: MS. BARBARA BALDASSARRE
Title or Position: OWNER
Credential: OTR/L
Phone: 708-917-9660