MEDICARE: COMPREHENSIVE PEDIATRICS LLC

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	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1083325328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE PEDIATRICS LLC

Provider Business Mailing Address
First Line	:	3412 N AVERS AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-5214
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3412 N AVERS AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-5214
Country	:	US
Telephone Number	:	847-962-0057
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	PAIGE KADEN
Credential	:
Telephone Number	:	847-962-0057

Provider Enumeration Date	:	12/07/2022
Last Update Date	:	12/10/2022

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