# INNOVATIONS PEDIATRIC THERAPY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003356817
- **Authorized official:** REBECCA L GOLLADAY OTR/L (OWNER)
- **Authorized official phone:** (309) 824-7417

## Contact information

- **Practice address:** 1 YOUNT DR, BLOOMINGTON, IL 61704-3745
- **Practice address phone:** (309) 824-7417
- **Mailing address:** 212 EDWARDS DR, NORMAL, IL 61761-2334
- **Mailing address phone:** (309) 824-7417
- **Mailing address fax:** (309) 408-0255

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225X00000X | Occupational Therapist | 056006902 | IL | Yes |
| 225XF0002X | Feeding, Eating & Swallowing Occupational Therapist | 056006902 | IL | — |
| 225XP0200X | Pediatric Occupational Therapist | 056006902 | IL | — |

## Other

- **Enumeration date:** 02/27/2017
- **Last updated:** 02/27/2017