Provider Demographics
NPI:1023775467
Name:OWLLIGHT THERAPY INC
Entity type:Organization
Organization Name:OWLLIGHT THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ZAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAOUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-949-0746
Mailing Address - Street 1:3617 DORA ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131-1613
Mailing Address - Country:US
Mailing Address - Phone:708-949-0746
Mailing Address - Fax:
Practice Address - Street 1:7222 W CERMAK RD STE 500
Practice Address - Street 2:
Practice Address - City:NORTH RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-1443
Practice Address - Country:US
Practice Address - Phone:866-695-2221
Practice Address - Fax:866-695-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL001Medicaid