Provider Demographics
NPI:1114105368
Name:TIME OUT THERAPY SERVICE
Entity Type:Organization
Organization Name:TIME OUT THERAPY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:O
Authorized Official - Last Name:TOPPS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:630-417-7555
Mailing Address - Street 1:1770 S RANDALL RD
Mailing Address - Street 2:A208
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4646
Mailing Address - Country:US
Mailing Address - Phone:630-896-2617
Mailing Address - Fax:630-896-2617
Practice Address - Street 1:1770 S RANDALL RD
Practice Address - Street 2:A208
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4646
Practice Address - Country:US
Practice Address - Phone:630-896-2617
Practice Address - Fax:630-896-2617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty