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NPI Code Detail

MEDICARE: M STREET PEDIATRIC THERAPY CORP

MEDICARE: M STREET PEDIATRIC THERAPY CORP
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
1225XP0200XPediatric Occupational Therapist
2235Z00000XSpeech-Language Pathologist
3101Y00000XCounselor
41041C0700XClinical Social Worker
52251P0200XPediatric Physical TherapistIL

General Provider Information

NPI Number : 1588193593
Entity Type Code : Organization
Provider Name (Legal Business Name) : M STREET PEDIATRIC THERAPY CORP
Provider Business Mailing Address
First Line : 719 N MARION ST
Second Line :
City : OAK PARK
State : IL
Zip : 60302-1530
Country : US
Telephone Number : 312-401-0975
Fax Number :
Provider Business Practice Location Address
First Line : 719 N MARION ST
Second Line :
City : OAK PARK
State : IL
Zip : 60302-1530
Country : US
Telephone Number : 312-401-0975
Fax Number :
Authorized Official
Title or Position : OWNER
Name : ALISON LIDDLE
Credential : PT, MPP, PCS
Telephone Number : 312-401-0975
Provider Enumeration Date : 06/05/2017
Last Update Date : 07/21/2022

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Directions to “M STREET PEDIATRIC THERAPY CORP ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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