Organization
OTHER SIDE OF THE RAINBOW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FREDERICA JOHNSON (PRESIDENT)
(708) 612-2881
Entity
Organization
Contact information
Practice address
22006 JORDAN LN, RICHTON PARK, IL 60471-1268
(708) 612-2881
Mailing address
22006 JORDAN LN, RICHTON PARK, IL 60471-1268
(708) 612-2881
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
03/09/2015
Last updated
03/09/2015
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