MEDICARE: PLAY WORKS THERAPIES, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA 6455	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043257678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAY WORKS THERAPIES, P.A.

Provider Business Mailing Address
First Line	:	12276 SAN JOSE BLVD
Second Line	:	SUITE 507
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8628
Country	:	US
Telephone Number	:	904-288-8910
Fax Number	:	904-288-8912

Provider Business Practice Location Address
First Line	:	12276 SAN JOSE BLVD
Second Line	:	SUITE 507
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8628
Country	:	US
Telephone Number	:	904-288-8910
Fax Number	:	904-288-8912

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JILL MALISZEWSKI
Credential	:	MA CCC/SLP
Telephone Number	:	904-288-8910

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	10/05/2015

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Directions to “PLAY WORKS THERAPIES, P.A. ” Practice Location

Language	Start Address	Practice Location

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