Healthcare Provider Details

I. General information

NPI: 1629856067
Provider Name (Legal Business Name): BUDDING BUDDIES THERAPEUTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12949 S MEADE AVE
PALOS HEIGHTS IL
60463-2355
US

IV. Provider business mailing address

12949 S MEADE AVE
PALOS HEIGHTS IL
60463-2355
US

V. Phone/Fax

Practice location:
  • Phone: 708-926-4090
  • Fax:
Mailing address:
  • Phone: 708-926-4090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: CLAIRE CALLAHAN
Title or Position: OCCUPATIONAL THERAPIST
Credential: MOT/R
Phone: 708-926-4090