Provider Demographics
NPI:1326555723
Name:SPECIALIZED PEDIATRIC OCCUPATIONAL THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:SPECIALIZED PEDIATRIC OCCUPATIONAL THERAPY SERVICES, LLC
Other - Org Name:SPOTS FOR FAMILIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MORADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-598-3011
Mailing Address - Street 1:748 RIEDY RD
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-2231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:748 RIEDY RD
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-2231
Practice Address - Country:US
Practice Address - Phone:314-598-3011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-07
Last Update Date:2018-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency