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General NPI Number Information
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NPI Number | 1861627127
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Entity Type | Organization
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Legal Business Name | CHRISTA HOLBERG PEDIATRIC THERAPY L.L.C
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Dates
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Enumeration Date | 05/15/2009
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Last Update Date | 05/15/2009
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Provider Practice Location Address
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Address Line | 2225 ENTERPRISE DR STE 2505
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City | WESTCHESTER
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State | IL
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Zip | 60154-5805
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Country | US
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Telephone | 773-456-4040
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Fax |
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Provider Business Mailing Address
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Address Line | 1453 E 54TH PL APT 3
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City | CHICAGO
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State | IL
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Zip | 60615-5428
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Country | US
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Telephone | 773-456-4040
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | CHRISTA MARIE HOLBERG
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Credential | MS, OTR/L
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Telephone | 773-456-4040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 056007669
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License Number State | IL
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