Healthcare Provider Details

I. General information

NPI: 1063358042
Provider Name (Legal Business Name): FUNCTIONAL LIVING CHILDREN'S THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11348 AUTUMN RIDGE DR
ORLAND PARK IL
60467-1342
US

IV. Provider business mailing address

11348 AUTUMN RIDGE DR
ORLAND PARK IL
60467-1342
US

V. Phone/Fax

Practice location:
  • Phone: 708-341-8318
  • Fax:
Mailing address:
  • Phone: 708-341-8318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JADE ALEXA PELLERITO
Title or Position: OWNER/OCCUPATIONAL THERAPIST
Credential:
Phone: 708-341-8318