Healthcare Provider Details

I. General information

NPI: 1023613791
Provider Name (Legal Business Name): SKILLED THERAPY & PLAY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 04/12/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 EL CAMINO REAL
SAN CARLOS CA
94070-2408
US

IV. Provider business mailing address

7 W 41ST AVE # 329
SAN MATEO CA
94403-5105
US

V. Phone/Fax

Practice location:
  • Phone: 650-200-6154
  • Fax:
Mailing address:
  • Phone: 650-200-6154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ERIN DENOLA
Title or Position: OCCUPATIONAL THERAPIST
Credential:
Phone: 650-200-6154