Provider Demographics
NPI:1487872073
Name:LOOMIS, CHRISTINE LOUISE (MAED)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:LOUISE
Last Name:LOOMIS
Suffix:
Gender:F
Credentials:MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6825 KINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1737
Mailing Address - Country:US
Mailing Address - Phone:708-404-5765
Mailing Address - Fax:
Practice Address - Street 1:6825 KINGSTON RD
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1737
Practice Address - Country:US
Practice Address - Phone:708-404-5765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILCL99000803P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist