Basic Information
| Provider Information | |||||||||
| NPI: | 1225499908 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORANGE PEDIATRIC THERAPY INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4000 GROVE ST | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600761712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129271982 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4000 GROVE ST | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600761712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129271982 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2016 | ||||||||
| LastUpdateDate: | 03/09/2016 | ||||||||
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| AuthorizedOfficialLastName: | SCHNEIDER | ||||||||
| AuthorizedOfficialFirstName: | BROOKE | ||||||||
| AuthorizedOfficialMiddleName: | ELLYN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/ BCBA | ||||||||
| AuthorizedOfficialTelephone: | 3129271982 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | M.S.ED., BCBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-13-12819 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.