Upstart Children's Therapy Ctr, LLC

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

Legal business name

UPSTART CHILDREN'S THERAPY CTR, LLC

Practice address

18909 Lorenz Ave
Lansing, IL 60438-3434

Phone

(708) 955-2213

NPI assigned

Jul 14, 2022

Last updated

Jul 14, 2022By 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

Ms. Donna Gibson

Title

President

Phone

(708) 955-2213

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1657756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657756800000",
    "number": "1912631870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18909 LORENZ AVE",
            "city": "LANSING",
            "state": "IL",
            "postal_code": "604383434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18909 LORENZ AVE",
            "city": "LANSING",
            "state": "IL",
            "postal_code": "604383434",
            "telephone_number": "708-955-2213"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18909 Lorenz Ave",
            "address_purpose": "LOCATION",
            "city": "Lansing",
            "state": "IL",
            "postal_code": "604383434",
            "country_code": "US",
            "telephone_number": "708-955-2213",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "UPSTART CHILDREN'S THERAPY CTR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-14",
        "last_updated": "2022-07-14",
        "certification_date": "2022-07-14",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-955-2213",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Occupational Therapist in Lansing, IL
• Providers in Lansing, 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 Jul 14, 2022; 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.