Provider Demographics
NPI:1306078738
Name:CHILDREN'S THERAPY SPOT
Entity type:Organization
Organization Name:CHILDREN'S THERAPY SPOT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:TASSINARI
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:618-466-6508
Mailing Address - Street 1:878 MARC DR
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-4268
Mailing Address - Country:US
Mailing Address - Phone:618-466-6508
Mailing Address - Fax:
Practice Address - Street 1:450 COTTONWOOD RD
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-2772
Practice Address - Country:US
Practice Address - Phone:618-977-4683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.006084261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center