Provider Demographics
NPI:1184130726
Name:LEAD THE WAY THERAPY
Entity type:Organization
Organization Name:LEAD THE WAY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AYMEN
Authorized Official - Middle Name:FATIMA
Authorized Official - Last Name:SHAKEEL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:630-407-7749
Mailing Address - Street 1:161 ROSEDALE CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1477
Mailing Address - Country:US
Mailing Address - Phone:630-407-7749
Mailing Address - Fax:
Practice Address - Street 1:161 ROSEDALE CT
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1477
Practice Address - Country:US
Practice Address - Phone:630-407-7749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056009916252Y00000X
IL056.009916225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty