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General NPI Number Information
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NPI Number | 1639733959
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Entity Type | Organization
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Legal Business Name | POP PEDIATRIC THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 04/23/2019
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Last Update Date | 04/23/2019
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Provider Practice Location Address
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Address Line | POP PEDIATRIC THERAPY 7421 MADISON AVE.
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City | FOREST PARK
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State | IL
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Zip | 60130
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Country | US
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Telephone | 708-351-5429
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Fax | 855-529-1595
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Provider Business Mailing Address
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Address Line | POP PEDIATRIC THERAPY 7421 MADISON AVE.
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City | FOREST PARK
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State | IL
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Zip | 60130
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Country | US
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Telephone | 708-351-5429
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Fax | 855-529-1595
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. DANIELLE JEAN LEMON
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Credential | OTD/OTR/L
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Telephone | 708-351-5429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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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 |
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License Number State |
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