Healthcare Provider Details

I. General information

NPI: 1457418089
Provider Name (Legal Business Name): CHILDS PLAY BY THE BAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 KINGS HWY
LEWES DE
19958-1707
US

IV. Provider business mailing address

1002 KINGS HWY
LEWES DE
19958-1707
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-2153
  • Fax: 302-645-2943
Mailing address:
  • Phone:
  • Fax: 302-645-2943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateDE

VIII. Authorized Official

Name: ALESIA GRIFFITH
Title or Position: PARTNER
Credential: OTR
Phone: 302-645-2153