NPIMap

Organization Active NPI

Play It Forward Pediatric Therapy, LLC

  • Occupational Therapist
  • Brookfield, IL
National Provider Identifier
1255615738
Registry record updated Jan 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
056.008322 Issued in IL
Legal business name
PLAY IT FORWARD PEDIATRIC THERAPY, LLC
Practice address
3134 Sunnyside Ave
Brookfield, IL 60513-1328
Phone
(630) 240-2135
Fax
(630) 563-1696
NPI assigned
Oct 3, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2019

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

Authorized official

Name
Theresa Marion BakulaNPI 1538335393
Title
Occupational Therapist
Phone
(708) 557-4249

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225X00000X 056.008322 IL Primary

Addresses

Primary practice location

3134 Sunnyside Ave
Brookfield, IL 60513-1328

Mailing address

3134 Sunnyside Ave
Brookfield, IL 60513-1328
Phone (630) 240-2135

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1317600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546992000000",
    "number": "1255615738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3134 SUNNYSIDE AVE",
            "city": "BROOKFIELD",
            "state": "IL",
            "postal_code": "605131328",
            "telephone_number": "630-240-2135",
            "fax_number": "630-563-1696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3134 SUNNYSIDE AVE",
            "city": "BROOKFIELD",
            "state": "IL",
            "postal_code": "605131328",
            "telephone_number": "630-240-2135",
            "fax_number": "630-563-1696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLAY IT FORWARD PEDIATRIC THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-03",
        "last_updated": "2019-01-09",
        "status": "A",
        "authorized_official_last_name": "BAKULA",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "MARION",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPIST",
        "authorized_official_telephone_number": "708-557-4249"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056.008322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2019; 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.