Provider Demographics
NPI:1356073316
Name:LAKESHORE AFFIRMATIVE THERAPY PLLC
Entity Type:Organization
Organization Name:LAKESHORE AFFIRMATIVE THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-749-5745
Mailing Address - Street 1:160 E NORTHWEST HWY APT E
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2273
Mailing Address - Country:US
Mailing Address - Phone:847-749-5745
Mailing Address - Fax:
Practice Address - Street 1:160 E NORTHWEST HWY APT E
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-2273
Practice Address - Country:US
Practice Address - Phone:847-749-5745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty