Provider Demographics
NPI:1912761420
Name:PEDIATRIC THERAPY SPECIALISTS PLLC
Entity type:Organization
Organization Name:PEDIATRIC THERAPY SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PASSARO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:847-312-6421
Mailing Address - Street 1:14 FAWN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60013-1069
Mailing Address - Country:US
Mailing Address - Phone:847-312-6421
Mailing Address - Fax:
Practice Address - Street 1:14 FAWN RIDGE DR
Practice Address - Street 2:
Practice Address - City:OAKWOOD HILLS
Practice Address - State:IL
Practice Address - Zip Code:60013-1069
Practice Address - Country:US
Practice Address - Phone:847-312-6421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty