Organization
INNOVATIONS PEDIATRIC THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA L GOLLADAY OTR/L (OWNER)
(309) 824-7417
Entity
Organization
Contact information
Practice address
1 YOUNT DR, BLOOMINGTON, IL 61704-3745
(309) 824-7417
Mailing address
212 EDWARDS DR, NORMAL, IL 61761-2334
(309) 824-7417
(309) 408-0255
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056006902
IL
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
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