Healthcare Provider Details

I. General information

NPI: 1487235248
Provider Name (Legal Business Name): THERAPLAY LA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 04/14/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 S LA BREA AVE
LOS ANGELES CA
90019-6905
US

IV. Provider business mailing address

1070 S LA BREA AVE
LOS ANGELES CA
90019-6905
US

V. Phone/Fax

Practice location:
  • Phone: 310-630-9084
  • Fax: 424-442-0298
Mailing address:
  • Phone: 310-630-9084
  • Fax: 424-442-0298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MARIELLY MITCHELL
Title or Position: FOUNDER
Credential: DOCTOR OF OT
Phone: 310-630-9084