Provider Demographics
NPI:1639394893
Name:HOPE'S PLAYGROUND PEDIATRIC THERAPY, INC.
Entity Type:Organization
Organization Name:HOPE'S PLAYGROUND PEDIATRIC THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MORNINGSTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR
Authorized Official - Phone:847-323-8057
Mailing Address - Street 1:311 W DEPOT ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-1500
Mailing Address - Country:US
Mailing Address - Phone:847-838-8085
Mailing Address - Fax:262-997-9403
Practice Address - Street 1:311 W DEPOT ST
Practice Address - Street 2:SUITE F
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-1500
Practice Address - Country:US
Practice Address - Phone:847-838-8085
Practice Address - Fax:224-788-8121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-14
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-005853225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty