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Contact Information

ABC PEDIATRIC THERAPY, LLC
634 N MAIN ST
SUITE 3
O'FALLON, IL62269-3746
 Phone: 618-632-4222
 Fax: 618-632-4658
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Speech-Language Pathologist

235Z00000X 15 Speech Language Pathologist
 

Occupational Therapist

225X00000X 67 Occupational Therapist in Private Practice
 

Physical Therapist

225100000X 65 Physical Therapist in Private Practice
Indicates primary specialty

NPI Profile & details for ABC PEDIATRIC THERAPY LLC · (Female)

NPI # 1124044698
Status Active
Credentials
Entity Individual
Enumeration date 07/15/2006
Last updated 06/17/2011 - About 15 years ago
Sole proprietor 1 Not specified
Identifiers
  • IL Medicaid 348620164001
  • IL Other 08232136 BLUE CROSS BLUE SHIELD
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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