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General NPI Number Information
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NPI Number | 1033002910
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Entity Type | Organization
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Legal Business Name | LAKESIDE SPECIALIZED PEDIATRIC OCCUPATIONAL THERAPY PLLC
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Dates
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Enumeration Date | 05/30/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 812 W LILL AVE APT 2
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City | CHICAGO
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State | IL
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Zip | 60614-0118
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Country | US
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Telephone | 312-342-9933
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Fax |
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Provider Business Mailing Address
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Address Line | 812 W LILL AVE APT 2
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City | CHICAGO
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State | IL
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Zip | 60614-0118
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Country | US
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Telephone | 312-342-9933
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Fax |
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Authorized Official
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Title or Position | MS OTR/:
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Name | SAMANTHA HOLZSCHU
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Credential |
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Telephone | 312-342-9933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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