NPI 1710308580

Over the Moon Pediatric Therapy Co

Organisation Early Intervention Provider Agency New Lenox, IL

Practice location

Address: 3308 Ivywild Ln, New Lenox, IL 60451-9517
Phone: (815) 212-0536

Authorised official

Name: Michele Valecek
Title: Owner
Phone: (815) 212-0536

Registered specialties

Early Intervention Provider Agency Primary

Agencies Taxonomy 252Y00000X Licence MV60460511P (IL)

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Registry record

NPI: 1710308580
Entity type: Organization
NPI issued: 21 Dec 2013
Record last updated: 21 Dec 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.