Basic Information
| Provider Information | |||||||||
| NPI: | 1033541677 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MILESTONE THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1470 SCHWARZ MEADOW DR | ||||||||
| Address2: | |||||||||
| City: | O FALLON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622696709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185580814 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11531 SWINFORD LN | ||||||||
| Address2: | |||||||||
| City: | MOKENA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604489274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2192290322 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2013 | ||||||||
| LastUpdateDate: | 08/06/2013 | ||||||||
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| AuthorizedOfficialLastName: | HIGHAM | ||||||||
| AuthorizedOfficialFirstName: | COLLEEN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OCCUPATIONAL THERAPY ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 6185580814 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | CERTIFIED OTA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 252Y00000X | 057003767 | IL | Y | Agencies | Early Intervention Provider Agency |
No ID Information.