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General NPI Number Information
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NPI Number | 1184130726
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Entity Type | Organization
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Legal Business Name | LEAD THE WAY THERAPY
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Dates
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Enumeration Date | 12/19/2017
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Last Update Date | 06/11/2021
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Provider Practice Location Address
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Address Line | 161 ROSEDALE CT
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1477
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Country | US
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Telephone | 630-407-7749
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Fax |
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Provider Business Mailing Address
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Address Line | 161 ROSEDALE CT
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1477
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Country | US
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Telephone | 630-407-7749
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC OCCUPATIONAL THERAPIST
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Name | AYMEN FATIMA SHAKEEL
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Credential | OTR/L
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Telephone | 630-407-7749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 056009916
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 056.009916
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License Number State | IL
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