Provider Demographics
NPI:1477927275
Name:KIDS CAN PEDIATRIC THERAPY INC.
Entity Type:Organization
Organization Name:KIDS CAN PEDIATRIC THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:RICHELLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RANDAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L
Authorized Official - Phone:708-250-1535
Mailing Address - Street 1:1530 S STATE ST
Mailing Address - Street 2:UNIT 525
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2964
Mailing Address - Country:US
Mailing Address - Phone:708-250-1535
Mailing Address - Fax:312-643-1316
Practice Address - Street 1:1530 S STATE ST
Practice Address - Street 2:UNIT 525
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2964
Practice Address - Country:US
Practice Address - Phone:708-250-1535
Practice Address - Fax:312-643-1316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007032225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty