Healthcare Provider Details

I. General information

NPI: 1124340856
Provider Name (Legal Business Name): PURPOSEFUL PLAY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3026 JUNIPER ST
SAN DIEGO CA
92104-5437
US

IV. Provider business mailing address

3026 JUNIPER ST
SAN DIEGO CA
92104-5437
US

V. Phone/Fax

Practice location:
  • Phone: 619-746-8231
  • Fax: 619-255-1639
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 5039
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License NumberOT 5039
License Number StateCA

VIII. Authorized Official

Name: TAD BRUNEAU
Title or Position: CEO
Credential:
Phone: 619-746-8231