Provider Demographics
NPI:1790122240
Name:LITTLE TIKES THERAPY, INC
Entity Type:Organization
Organization Name:LITTLE TIKES THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:708-334-1095
Mailing Address - Street 1:621 HIGH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-1407
Mailing Address - Country:US
Mailing Address - Phone:708-334-1095
Mailing Address - Fax:866-834-3810
Practice Address - Street 1:621 HIGH RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-1407
Practice Address - Country:US
Practice Address - Phone:708-334-1095
Practice Address - Fax:866-834-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency