Healthcare Provider Details

I. General information

NPI: 1912632043
Provider Name (Legal Business Name): PLAY THROUGH THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6195 SW 160TH TER
DAVIE FL
33331-3451
US

IV. Provider business mailing address

6195 SW 160TH TER
DAVIE FL
33331-3451
US

V. Phone/Fax

Practice location:
  • Phone: 786-402-4157
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JESSICA PONCE
Title or Position: PRESIDENT
Credential: COTA/L
Phone: 786-402-4157