Provider Demographics
NPI:1699120832
Name:HAND TO HAND PEDIATRIC THERAPY
Entity type:Organization
Organization Name:HAND TO HAND PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:618-407-1396
Mailing Address - Street 1:4941 BENCHMARK CENTRE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2038
Mailing Address - Country:US
Mailing Address - Phone:618-628-3540
Mailing Address - Fax:618-628-3249
Practice Address - Street 1:4941 BENCHMARK CENTRE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2038
Practice Address - Country:US
Practice Address - Phone:618-628-3540
Practice Address - Fax:618-628-3249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056004907302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization