Healthcare Provider Details

I. General information

NPI: 1952211922
Provider Name (Legal Business Name): LIL LUMENS OCCUPATIONAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 WILLIAMS DR
SOUTH ELGIN IL
60177-2538
US

IV. Provider business mailing address

620 WILLIAMS DR
SOUTH ELGIN IL
60177-2538
US

V. Phone/Fax

Practice location:
  • Phone: 630-456-2423
  • Fax:
Mailing address:
  • Phone: 630-456-2423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: NICOLE M GOMEZ
Title or Position: OCCUPATIONAL THERAPIST/MANAGER
Credential:
Phone: 630-456-2423