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General NPI Number Information
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NPI Number | 1477927275
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Entity Type | Organization
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Legal Business Name | KIDS CAN PEDIATRIC THERAPY INC.
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Dates
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Enumeration Date | 11/17/2015
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Last Update Date | 11/17/2015
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Provider Practice Location Address
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Address Line | 1530 S STATE ST UNIT 525
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City | CHICAGO
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State | IL
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Zip | 60605-2964
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Country | US
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Telephone | 708-250-1535
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Fax | 312-643-1316
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Provider Business Mailing Address
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Address Line | 1530 S STATE ST UNIT 525
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City | CHICAGO
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State | IL
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Zip | 60605-2964
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Country | US
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Telephone | 708-250-1535
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Fax | 312-643-1316
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MISS RICHELLE LYNN RANDAZZO
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Credential | OTD, OTR/L
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Telephone | 708-250-1535
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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 | 056007032
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License Number State | IL
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