Provider Demographics
NPI:1821380379
Name:OMEGA THERAPY SERVICES, INC
Entity Type:Organization
Organization Name:OMEGA THERAPY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWBER
Authorized Official - Prefix:
Authorized Official - First Name:LV
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:SLP
Authorized Official - Phone:847-477-9689
Mailing Address - Street 1:PO BOX 1944
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-7664
Mailing Address - Country:US
Mailing Address - Phone:847-477-9689
Mailing Address - Fax:815-254-3611
Practice Address - Street 1:1276 TWILIGHT WAY
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-4951
Practice Address - Country:US
Practice Address - Phone:847-477-9689
Practice Address - Fax:815-254-3611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty