Innovations Pediatric Therapy, LLC

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

056006902 Issued in IL

Legal business name

INNOVATIONS PEDIATRIC THERAPY, LLC

Practice address

1 Yount Dr
Bloomington, IL 61704-3745

Phone

(309) 824-7417

NPI assigned

Feb 27, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rebecca L Golladay, OTR/LNPI 1720284151

Title

Owner

Phone

(309) 824-7417

Specialties & licenses 3

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rebecca L Golladay, OTR-L

  • Pediatric Occupational Therapist
  • Normal, IL
  • NPI 1720284151

  Pediatrics

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1488153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488153600000",
    "number": "1003356817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 EDWARDS DR",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617612334",
            "telephone_number": "309-824-7417",
            "fax_number": "309-408-0255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 YOUNT DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043745",
            "telephone_number": "309-824-7417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIONS PEDIATRIC THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-27",
        "last_updated": "2017-02-27",
        "status": "A",
        "authorized_official_last_name": "GOLLADAY",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-824-7417",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056006902",
            "primary": true
        },
        {
            "code": "225XF0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Feeding, Eating & Swallowing",
            "state": "IL",
            "license": "056006902",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "IL",
            "license": "056006902",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Occupational Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.