Provider Demographics
NPI:1215108741
Name:SWEDISH AMERICAN PEDIATRIC THERAPY SERVICES
Entity type:Organization
Organization Name:SWEDISH AMERICAN PEDIATRIC THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:815-489-4470
Mailing Address - Street 1:209 9TH ST STE 302
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104-2235
Mailing Address - Country:US
Mailing Address - Phone:815-489-4470
Mailing Address - Fax:815-490-5858
Practice Address - Street 1:209 9TH ST STE 302
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-2235
Practice Address - Country:US
Practice Address - Phone:815-489-4470
Practice Address - Fax:815-490-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency