Innovative Pediatrics LLC

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

Legal business name

INNOVATIVE PEDIATRICS LLC

Practice address

1048 W Lawrence Ave
#1
Chicago, IL 60640-6544

Phone

(773) 968-7871

Fax

(773) 561-6815

NPI assigned

Jan 29, 2007

Last updated

Feb 6, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Bryan David Mattson, OTRNPI 1194929430

Title

LLC Manager

Phone

(773) 968-7871

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bryan D. Mattson, OTR

  • Pediatric Occupational Therapist
  • Chicago, IL
  • NPI 1194929430

  Pediatrics

  NPD (past) Authorized official

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202256000000",
    "number": "1841336922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 408799",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606408799",
            "telephone_number": "773-968-7871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1048 W LAWRENCE AVE",
            "address_2": "#1",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606406544",
            "telephone_number": "773-968-7871",
            "fax_number": "773-561-6815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2008-02-06",
        "status": "A",
        "authorized_official_last_name": "MATTSON",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "LLC MANAGER",
        "authorized_official_telephone_number": "773-968-7871",
        "authorized_official_credential": "OTR"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL BLUE CROSS PROVIDER #",
            "identifier": "01628182",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Innovative Express Care, SC
• Innovative Health Management Inc
• Innovative IV Care, PLLC
• Innovative Medspa PLLC
• Innovative Pediatric Therapy, Inc.
• Innovative Platinum Care, SC
• Innovative Social Work Solutions, P.C. (Isws)
• Innovative Therapy Solutions, LLC
• Ruben Inocencio, MD
• Lenka Inostroza

• Pediatric Occupational Therapist in Chicago, IL
• Providers in Chicago, IL by specialty
• Pediatric Occupational Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2008; 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.