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General NPI Number Information
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NPI Number | 1801249891
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Entity Type | Organization
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Legal Business Name | MODULATION THERAPY SERVICES LLC
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Dates
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Enumeration Date | 07/14/2016
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Last Update Date | 07/14/2016
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Provider Practice Location Address
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Address Line | 406 BLAINE ST
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City | BATAVIA
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State | IL
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Zip | 60510-2909
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Country | US
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Telephone | 630-995-1920
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Fax |
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Provider Business Mailing Address
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Address Line | 406 BLAINE ST
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City | BATAVIA
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State | IL
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Zip | 60510-2909
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Country | US
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Telephone | 630-995-1920
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Fax |
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Authorized Official
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Title or Position | OWNER/OCCUPATIONAL THERAPIST
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Name | CHRISTINA MARIE DEANO
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Credential | MS, OTR/L
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Telephone | 630-995-1920
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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 | 056009768
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License Number State | IL
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