Organization
MY RECESS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BROOKE SHEREE BACKSEN (PRESIDENT)
(312) 841-0993
Entity
Organization
Contact information
Practice address
1601 E MAIN ST, STE G, ST CHARLES, IL 60174-2431
(630) 880-0993
Mailing address
1601 E MAIN ST, STE G, ST CHARLES, IL 60174-2431
(630) 880-0993
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
05/28/2013
Last updated
09/27/2018
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