Healthcare Provider Details

I. General information

NPI: 1538609771
Provider Name (Legal Business Name): PLAYWELL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 TENNESSEE AVE NE
WASHINGTON DC
20002-5433
US

IV. Provider business mailing address

447 TENNESSEE AVE NE
WASHINGTON DC
20002-5433
US

V. Phone/Fax

Practice location:
  • Phone: 804-366-6647
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT010000451
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP000685
License Number StateDC

VIII. Authorized Official

Name: SARAH LARYEA
Title or Position: OWNER
Credential: M.S. OTR/L
Phone: 804-366-6647