Basic Information
| Provider Information | |||||||||
| NPI: | 1215108741 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SWEDISH AMERICAN PEDIATRIC THERAPY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 209 9TH ST STE 302 | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611042235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154894470 | ||||||||
| FaxNumber: | 8154905858 | ||||||||
| Practice Location | |||||||||
| Address1: | 209 9TH ST STE 302 | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611042235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154894470 | ||||||||
| FaxNumber: | 8154905858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2008 | ||||||||
| LastUpdateDate: | 03/12/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ROBERTS | ||||||||
| AuthorizedOfficialFirstName: | MONICA | ||||||||
| AuthorizedOfficialMiddleName: | ELAINE | ||||||||
| AuthorizedOfficialTitleorPosition: | OCCUPATIONAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 8154894470 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | O.T. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 252Y00000X | IL | Y | Agencies | Early Intervention Provider Agency |
No ID Information.