Provider Demographics
NPI:1497440986
Name:OPTIMUM CHILDREN'S THERAPY LLC
Entity Type:Organization
Organization Name:OPTIMUM CHILDREN'S THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, BCBA
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLIE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:319-325-0843
Mailing Address - Street 1:9333 S HARLEM AVE APT 4B
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2089
Mailing Address - Country:US
Mailing Address - Phone:319-325-0843
Mailing Address - Fax:
Practice Address - Street 1:9333 S HARLEM AVE APT 4B
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2089
Practice Address - Country:US
Practice Address - Phone:319-325-0843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty