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General NPI Number Information
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NPI Number | 1821380379
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Entity Type | Organization
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Legal Business Name | OMEGA THERAPY SERVICES, INC
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Dates
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Enumeration Date | 05/03/2011
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 1276 TWILIGHT WAY
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City | BOLINGBROOK
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State | IL
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Zip | 60490-4951
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Country | US
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Telephone | 847-477-9689
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Fax | 815-254-3611
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Provider Business Mailing Address
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Address Line | PO BOX 1944
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City | BOLINGBROOK
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State | IL
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Zip | 60440-7664
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Country | US
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Telephone | 847-477-9689
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Fax | 815-254-3611
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Authorized Official
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Title or Position | OWBER
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Name | LV TUCKER JR.
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Credential | SLP
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Telephone | 847-477-9689
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State | IL
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