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General NPI Number Information
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NPI Number | 1255615738
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Entity Type | Organization
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Legal Business Name | PLAY IT FORWARD PEDIATRIC THERAPY, LLC
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Dates
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Enumeration Date | 10/03/2011
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Last Update Date | 01/09/2019
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Provider Practice Location Address
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Address Line | 3134 SUNNYSIDE AVE
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City | BROOKFIELD
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State | IL
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Zip | 60513-1328
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Country | US
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Telephone | 630-240-2135
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Fax | 630-563-1696
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Provider Business Mailing Address
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Address Line | 3134 SUNNYSIDE AVE
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City | BROOKFIELD
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State | IL
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Zip | 60513-1328
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Country | US
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Telephone | 630-240-2135
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Fax | 630-563-1696
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | THERESA MARION BAKULA
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Credential |
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Telephone | 708-557-4249
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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 | 056.008322
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License Number State | IL
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