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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