MEDICARE: LITTLE LEAPS OF LEARNING, 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	222Q00000X	Developmental Therapist	KS67821000P	IL

General Provider Information

NPI Number	:	1427421536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE LEAPS OF LEARNING, INC.

Provider Business Mailing Address
First Line	:	10956 MASSASOIT AVE
Second Line	:
City	:	CHICAGO RIDGE
State	:	IL
Zip	:	60415-2417
Country	:	US
Telephone Number	:	708-369-3613
Fax Number	:	708-346-0115

Provider Business Practice Location Address
First Line	:	10956 MASSASOIT AVE
Second Line	:
City	:	CHICAGO RIDGE
State	:	IL
Zip	:	60415-2417
Country	:	US
Telephone Number	:	708-369-3613
Fax Number	:	708-346-0115

Authorized Official
Title or Position	:	SECRETARY
Name	:	MR. SCOTT D SISK
Credential	:
Telephone Number	:	708-369-3613

Provider Enumeration Date	:	11/11/2015
Last Update Date	:	11/11/2015

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