Provider Demographics
NPI:1497886352
Name:DISTINCTIVE DEVELOPMENTAL THERAPY SERVICES INC
Entity Type:Organization
Organization Name:DISTINCTIVE DEVELOPMENTAL THERAPY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:DT DEVELOPMENTAL THE
Authorized Official - Phone:773-505-2357
Mailing Address - Street 1:1842 S HOME AVE
Mailing Address - Street 2:#2
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-1618
Mailing Address - Country:US
Mailing Address - Phone:773-505-2357
Mailing Address - Fax:708-788-0967
Practice Address - Street 1:1842 S HOME AVE
Practice Address - Street 2:#2
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-1618
Practice Address - Country:US
Practice Address - Phone:773-505-2357
Practice Address - Fax:708-788-0967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILMA42490698P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty