MEDICARE: PLAY PATCH THERAPY

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	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1265369193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAY PATCH THERAPY

Provider Business Mailing Address
First Line	:	5234 SW 159TH AVE
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-4993
Country	:	US
Telephone Number	:	954-701-7500
Fax Number	:

Provider Business Practice Location Address
First Line	:	5234 SW 159TH AVE
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-4993
Country	:	US
Telephone Number	:	954-701-7500
Fax Number	:

Authorized Official
Title or Position	:	MGR
Name	:	TIFFANY ALEXANDRA GONZALEZ
Credential	:	OTR/L
Telephone Number	:	954-701-7500

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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Directions to “PLAY PATCH THERAPY ” Practice Location

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