MEDICARE: LITTLE EXPLORERS 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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1154839512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE EXPLORERS LLC

Provider Business Mailing Address
First Line	:	4346 N WOLCOTT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1020
Country	:	US
Telephone Number	:	847-414-0459
Fax Number	:

Provider Business Practice Location Address
First Line	:	4346 N WOLCOTT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1020
Country	:	US
Telephone Number	:	847-414-0459
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ANETA M ESPINOSA
Credential	:	OTA
Telephone Number	:	847-414-0459

Provider Enumeration Date	:	01/18/2018
Last Update Date	:	01/18/2018

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Directions to “LITTLE EXPLORERS LLC ” Practice Location

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