Healthcare Provider Details

I. General information

NPI: 1619033610
Provider Name (Legal Business Name): BARBARA BALDASSARRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 S MADISON AVE.
LAGRANGE IL
60525-2801
US

IV. Provider business mailing address

504 S. MADISON
LA GRANGE IL
60525
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: