MEDICARE: OWLLIGHT THERAPY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023775467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OWLLIGHT THERAPY INC

Provider Business Mailing Address
First Line	:	3617 DORA ST
Second Line	:
City	:	FRANKLIN PARK
State	:	IL
Zip	:	60131-1613
Country	:	US
Telephone Number	:	708-949-0746
Fax Number	:

Provider Business Practice Location Address
First Line	:	7222 W CERMAK RD STE 500
Second Line	:
City	:	NORTH RIVERSIDE
State	:	IL
Zip	:	60546-1443
Country	:	US
Telephone Number	:	866-695-2221
Fax Number	:	866-695-2221

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	ZAINA DAOUD
Credential	:
Telephone Number	:	708-949-0746

Provider Enumeration Date	:	11/19/2021
Last Update Date	:	08/31/2022

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Directions to “OWLLIGHT THERAPY INC ” Practice Location

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