Provider Demographics
NPI:1033541677
Name:MILESTONE THERAPY
Entity Type:Organization
Organization Name:MILESTONE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPY ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HIGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED OTA
Authorized Official - Phone:618-558-0814
Mailing Address - Street 1:1470 SCHWARZ MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-6709
Mailing Address - Country:US
Mailing Address - Phone:618-558-0814
Mailing Address - Fax:
Practice Address - Street 1:11531 SWINFORD LN
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-9274
Practice Address - Country:US
Practice Address - Phone:219-229-0322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057003767252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency