Abc Pediatric Therapy, LLC
Speech-Language Pathologist, in O Fallon, IL. Organization (NPI-2).
NPI number1124044698
StatusActive
Last updated in NPPESJun 17, 2011
Details
- NPI
- 1124044698
- Entity type
- Organization (NPI-2)
- Legal business name
- Abc Pediatric Therapy, LLC
- Organization subpart
- No
- Enumeration date
- Jul 15, 2006
- Last updated
- Jun 17, 2011
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 235Z00000X | Speech-Language Pathologist, | – | – | Yes |
| 225X00000X | Occupational Therapist | – | – | |
| 225100000X | Physical Therapist | – | – |
Practice location
634 N Main StSuite 3
O Fallon, IL 62269-3746
Phone 618-632-4222 · Fax 618-632-4658
Mailing address
634 N Main StSuite 3
O Fallon, IL 62269-3746
Phone 618-632-4222 · Fax 618-632-4658
Authorized official
Amy L. Bruce
Owner
6186324222
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