Provider Demographics
NPI:1134819550
Name:PIVOTAL PEDIATRIC THERAPY, PLLC
Entity type:Organization
Organization Name:PIVOTAL PEDIATRIC THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:ARIANNA
Authorized Official - Last Name:PHILBRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:708-417-1767
Mailing Address - Street 1:2602 SAN MATEO DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-8453
Mailing Address - Country:US
Mailing Address - Phone:708-417-1767
Mailing Address - Fax:
Practice Address - Street 1:2602 SAN MATEO DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-8453
Practice Address - Country:US
Practice Address - Phone:708-417-1767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty