Healthcare Provider Details

I. General information

NPI: 1437547551
Provider Name (Legal Business Name): PLAY2GROW PEDIATRIC THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6768 9TH AVE
SACRAMENTO CA
95820-2106
US

IV. Provider business mailing address

5714 FOLSOM BLVD PLAY2GROW PEDIATRIC THERAPY #297
SACRAMENTO CA
95819-4608
US

V. Phone/Fax

Practice location:
  • Phone: 916-834-4379
  • Fax:
Mailing address:
  • Phone: 916-834-4379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License NumberOT 7936
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 7936
License Number StateCA

VIII. Authorized Official

Name: REBECCA O'CALLAGHAN
Title or Position: PRESIDENT & CEO
Credential: M.S., OTR/L, SWC
Phone: 916-834-4379