Healthcare Provider Details

I. General information

NPI: 1285157842
Provider Name (Legal Business Name): PLAY 2 PROGRESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 10/26/2022
Certification Date: 10/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12205 1/2 VENTURA
STUDIO CITY CA
91604
US

IV. Provider business mailing address

12205 1/2 VENTURA
STUDIO CITY CA
91604
US

V. Phone/Fax

Practice location:
  • Phone: 818-358-3535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. ALLIE TICKTIN
Title or Position: FOUNDER
Credential: OTR/L, OTD
Phone: 248-935-9107