=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144492125
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEPPING STONES THERAPEUTICS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2008
-----------------------------------------------------
Last Update Date | 03/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3236 S BELL AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60608-6007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-454-7663
-----------------------------------------------------
Fax | 773-927-9440
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3236 S BELL AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60608-6007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-454-7663
-----------------------------------------------------
Fax | 773-927-9440
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OCCUPATIONAL THERAPIST
-----------------------------------------------------
Name | MS. ESMERALDA VAZQUEZ
-----------------------------------------------------
Credential | OTR'L
-----------------------------------------------------
Telephone | 773-454-7663
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------