MEDICARE: LITTLE FOOT THERAPY, PLLC

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	:	1477193233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE FOOT THERAPY, PLLC

Provider Business Mailing Address
First Line	:	4430 N CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3804
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4430 N CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3804
Country	:	US
Telephone Number	:	630-247-9804
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OCCUPATIONALTHERAPIST
Name	:	SHANNON CULLERTON
Credential	:
Telephone Number	:	630-247-9804

Provider Enumeration Date	:	01/09/2020
Last Update Date	:	01/09/2020

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