Provider Demographics
NPI:1235253410
Name:KIDPOWER THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:KIDPOWER THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KOREY
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:847-831-1477
Mailing Address - Street 1:1450 OLD SKOKIE RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3032
Mailing Address - Country:US
Mailing Address - Phone:847-831-1477
Mailing Address - Fax:847-831-1336
Practice Address - Street 1:1450 OLD SKOKIE RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3032
Practice Address - Country:US
Practice Address - Phone:847-831-1477
Practice Address - Fax:847-831-1336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04932193OtherBCBS PROVIDER NUMBER