Provider Demographics
NPI:1861839193
Name:MY RECESS INC
Entity Type:Organization
Organization Name:MY RECESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:SHEREE
Authorized Official - Last Name:BACKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-841-0993
Mailing Address - Street 1:1601 E MAIN ST
Mailing Address - Street 2:STE G
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2431
Mailing Address - Country:US
Mailing Address - Phone:630-880-0993
Mailing Address - Fax:
Practice Address - Street 1:1601 E MAIN ST
Practice Address - Street 2:STE G
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2431
Practice Address - Country:US
Practice Address - Phone:630-880-0993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-28
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty