MEDICARE: PLAY TO LEARN THERAPY, INC.

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	174400000X	Specialist	OT15216	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	:	1366995573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAY TO LEARN THERAPY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 160591
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33116-0591
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10841 SW 128TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-5442
Country	:	US
Telephone Number	:	786-553-1720
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MS. LORIN N HEAGAN
Credential	:	MOT, OTR/L
Telephone Number	:	786-553-1720

Provider Enumeration Date	:	07/25/2016
Last Update Date	:	07/25/2016

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Directions to “PLAY TO LEARN THERAPY, INC. ” Practice Location

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