Provider Demographics
NPI:1639733959
Name:POP PEDIATRIC THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:POP PEDIATRIC THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:LEMON
Authorized Official - Suffix:
Authorized Official - Credentials:OTD/OTR/L
Authorized Official - Phone:708-351-5429
Mailing Address - Street 1:POP PEDIATRIC THERAPY
Mailing Address - Street 2:7421 MADISON AVE.
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130
Mailing Address - Country:US
Mailing Address - Phone:708-351-5429
Mailing Address - Fax:855-529-1595
Practice Address - Street 1:POP PEDIATRIC THERAPY
Practice Address - Street 2:7421 MADISON AVE.
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130
Practice Address - Country:US
Practice Address - Phone:708-351-5429
Practice Address - Fax:855-529-1595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty