NPI 1124044698 · live from the CMS NPI Registry
Abc Pediatric Therapy, LLC
Speech-Language Pathologist, in O Fallon, IL. National Provider Identifier 1124044698, active.
NPI record
| NPI | 1124044698 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Speech-Language Pathologist, 235Z00000X |
| Practice location | 634 N Main St, Suite 3, O Fallon, IL 62269 |
| Practice phone | 618-632-4222 |
| Enumerated | July 15, 2006 |
| Last updated | June 17, 2011 |
| Authorized official | Amy Bruce, Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Occupational Therapist | 225X00000X | — |
| Physical Therapist | 225100000X | — |
| Speech-Language Pathologist, primary | 235Z00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.