Provider Demographics
NPI:1154961829
Name:NEUROBEAT LLC
Entity type:Organization
Organization Name:NEUROBEAT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE KELVIN
Authorized Official - Middle Name:TOLENTINO
Authorized Official - Last Name:ESGUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L,CLT,SFS
Authorized Official - Phone:312-351-9675
Mailing Address - Street 1:201 N TYLER RD
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2362
Mailing Address - Country:US
Mailing Address - Phone:312-351-9675
Mailing Address - Fax:
Practice Address - Street 1:201 N TYLER RD
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2362
Practice Address - Country:US
Practice Address - Phone:312-351-9675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-10
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty