Provider Demographics
NPI:1164817920
Name:ACCESS PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:ACCESS PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OCCUPATONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:847-707-2012
Mailing Address - Street 1:1149 SADDLE RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-3323
Mailing Address - Country:US
Mailing Address - Phone:847-462-9750
Mailing Address - Fax:847-462-9751
Practice Address - Street 1:1149 SADDLE RIDGE TRL
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-3323
Practice Address - Country:US
Practice Address - Phone:847-462-9750
Practice Address - Fax:847-462-9751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056001812225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty