MEDICARE: MY RECESS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2251P0200X	Pediatric Physical Therapist
2	235Z00000X	Speech-Language Pathologist
3	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1861839193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY RECESS INC

Provider Business Mailing Address
First Line	:	1601 E MAIN ST
Second Line	:	STE G
City	:	ST CHARLES
State	:	IL
Zip	:	60174-2431
Country	:	US
Telephone Number	:	630-880-0993
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 E MAIN ST
Second Line	:	STE G
City	:	ST CHARLES
State	:	IL
Zip	:	60174-2431
Country	:	US
Telephone Number	:	630-880-0993
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BROOKE SHEREE BACKSEN
Credential	:
Telephone Number	:	312-841-0993

Provider Enumeration Date	:	05/28/2013
Last Update Date	:	09/27/2018

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Directions to “MY RECESS INC ” Practice Location

Language	Start Address	Practice Location

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