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General NPI Number Information
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NPI Number | 1467725119
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Entity Type | Organization
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Legal Business Name | EASTER SEALS
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Dates
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Enumeration Date | 02/10/2012
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Last Update Date | 02/10/2012
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Provider Practice Location Address
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Address Line | 10039 CAMBRIDGE CT
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City | MOKENA
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State | IL
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Zip | 60448
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Country | US
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Telephone | 708-261-3488
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Fax |
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Provider Business Mailing Address
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Address Line | 10039 CAMBRIDGE CT
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City | MOKENA
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State | IL
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Zip | 60448-7920
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR PEDIATRIC SERVICES
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Name | CHRISTINE TOMMASINO
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Credential |
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Telephone | 815-725-2190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 056008027
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License Number State | IL
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