Healthcare Provider Details

I. General information

NPI: 1023775467
Provider Name (Legal Business Name): OWLLIGHT THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7222 W CERMAK RD STE 500
NORTH RIVERSIDE IL
60546-1443
US

IV. Provider business mailing address

3617 DORA ST
FRANKLIN PARK IL
60131-1613
US

V. Phone/Fax

Practice location:
  • Phone: 866-695-2221
  • Fax: 866-695-2221
Mailing address:
  • Phone: 708-949-0746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: ZAINA DAOUD
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 708-949-0746