Brain Abc's

Primary specialty

Developmental TherapistTaxonomy code 222Q00000X

License

222Q00000X Issued in IL

Legal business name

BRAIN ABC'S

Practice address

213 S Princeton Ave
Villa Park, IL 60181-2535

Phone

(708) 805-0653

NPI assigned

Oct 17, 2016

Last updated

Oct 17, 2016By the provider in NPPES

Organization subpart

Yes

Parent organization

BRAIN ABC'SAs reported in NPPES

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

Authorized official

Name

Ms. Pamela A Cavallo, M.ED

Title

Owner/Developmental Therapist

Phone

(708) 805-0653

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Pamela Cavallo Other name

Part of

Brain Abc's

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

{
    "created_epoch": "1476662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476662400000",
    "number": "1316498124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 S PRINCETON AVE",
            "city": "VILLA PARK",
            "state": "IL",
            "postal_code": "601812535",
            "telephone_number": "708-805-0653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 S PRINCETON AVE",
            "city": "VILLA PARK",
            "state": "IL",
            "postal_code": "601812535",
            "telephone_number": "708-805-0653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAIN ABC'S",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRAIN ABC'S",
        "enumeration_date": "2016-10-17",
        "last_updated": "2016-10-17",
        "status": "A",
        "authorized_official_last_name": "CAVALLO",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/DEVELOPMENTAL THERAPIST",
        "authorized_official_telephone_number": "708-805-0653",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.ED"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Developmental Therapist",
            "state": "IL",
            "license": "222Q00000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEVELOPMENTAL THERAPIST",
            "identifier": "1720290679",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAXONOMY",
            "identifier": "222Q00000X",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pamela Cavallo",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Ava Lavon Blalark, LCSW
• Jennifer A Blevins
• Fred C Blumhagen, RPH
• Jamie Ann Bodden, M.S.CCC/SLP
• Vito Bottalico, DOCTOR OF PHARMACY
• Barbara A. Brown
• Tuiana Brown
• Tymikee L Brownhassan, LSW
• Laura Diane Bueche, OTR/L
• Tina L. Bungert, OTR/L

• Developmental Therapist in Villa Park, IL
• Providers in Villa Park, IL by specialty
• Developmental Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2016; 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.