Healthcare Provider Details

I. General information

NPI: 1962795575
Provider Name (Legal Business Name): CHILDREN'S THERAPLAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3553 NW 25TH WAY
BOCA RATON FL
33434-3415
US

IV. Provider business mailing address

3553 NW 25TH WAY
BOCA RATON FL
33434-3415
US

V. Phone/Fax

Practice location:
  • Phone: 561-716-4657
  • Fax:
Mailing address:
  • Phone: 561-716-4657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number7485
License Number StateFL

VIII. Authorized Official

Name: MRS. LISA GEMA FELDMAN
Title or Position: MANAGING MEMBER
Credential: OTR/L
Phone: 561-716-4657