Organization
OVER THE MOON PEDIATRIC THERAPY CO
Active
Organization
OVER THE MOON PEDIATRIC THERAPY CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELE VALECEK (OWNER)
(815) 212-0536
Entity
Organization
Contact information
Practice address
3308 IVYWILD LN, NEW LENOX, IL 60451-9517
(815) 212-0536
Mailing address
3308 IVYWILD LN, NEW LENOX, IL 60451-9517
(815) 212-0536
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
MV60460511P
IL
Other
Enumeration date
12/21/2013
Last updated
12/21/2013
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