=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801066048
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALING HANDS SPLINTING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2008
-----------------------------------------------------
Last Update Date | 03/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 N MOHAWK ST UNIT B
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60610-1114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-813-0015
-----------------------------------------------------
Fax | 312-337-0115
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 N MOHAWK ST UNIT B
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60610-1114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-813-0015
-----------------------------------------------------
Fax | 312-337-0115
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OCCUPATIONAL THERAPIST
-----------------------------------------------------
Name | MISS JARITA GAY THOMPSON
-----------------------------------------------------
Credential | OTR/L
-----------------------------------------------------
Telephone | 312-813-0015
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------