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General NPI Number Information
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NPI Number | 1003094996
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Entity Type | Organization
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Legal Business Name | PEDIATRICS IN MOTION
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Dates
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Enumeration Date | 02/04/2008
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Last Update Date | 02/04/2008
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Provider Practice Location Address
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Address Line | 36550 N HUNT CLUB RD SUITE PFP
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City | GURNEE
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State | IL
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Zip | 60031-1633
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Country | US
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Telephone | 262-206-1567
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Fax | 262-248-9479
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Provider Business Mailing Address
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Address Line | PO BOX 306
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City | WADSWORTH
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State | IL
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Zip | 60083-0306
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Country | US
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Telephone | 262-206-1567
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Fax | 262-248-9479
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MRS. AMANDA J BRADEN
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Credential | OTR/L
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Telephone | 262-206-1567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State | IL
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