Provider Demographics
NPI:1467901488
Name:LIFE SKILLS OCCUPATIONAL THERAPY LLC
Entity Type:Organization
Organization Name:LIFE SKILLS OCCUPATIONAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:LAURIA
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:331-305-3332
Mailing Address - Street 1:919 MORTONSBERRY DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-0364
Mailing Address - Country:US
Mailing Address - Phone:331-305-3332
Mailing Address - Fax:331-215-4711
Practice Address - Street 1:919 MORTONSBERRY DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-0364
Practice Address - Country:US
Practice Address - Phone:331-305-3332
Practice Address - Fax:331-215-4711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007182225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty