Healthcare Provider Details

I. General information

NPI: 1073709291
Provider Name (Legal Business Name): LITTLE FEET, BIG STEPS PEDIATRIC THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 11/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S GRANT ST
WESTMONT IL
60559-1803
US

IV. Provider business mailing address

15 S GRANT ST
WESTMONT IL
60559-1803
US

V. Phone/Fax

Practice location:
  • Phone: 630-202-5502
  • Fax: 630-202-5502
Mailing address:
  • Phone: 630-202-5502
  • Fax: 630-262-8231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056-005762
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEBORAH MYSZKOWSKI
Title or Position: PRESIDENT
Credential: OTR/L
Phone: 630-202-5502