Healthcare Provider Details

I. General information

NPI: 1851978340
Provider Name (Legal Business Name): PLAY FOR LIFE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W MIDLAND AVE
WOODLAND PARK CO
80863-3196
US

IV. Provider business mailing address

56 ASPEN CIR
DIVIDE CO
80814-9611
US

V. Phone/Fax

Practice location:
  • Phone: 662-832-8017
  • Fax:
Mailing address:
  • Phone: 662-832-8017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: STACI HARRELL
Title or Position: OCCUPATIONAL THERAPIST
Credential: MOTR/L
Phone: 662-832-8017