Healthcare Provider Details

I. General information

NPI: 1265369193
Provider Name (Legal Business Name): PLAY PATCH THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5234 SW 159TH AVE
MIRAMAR FL
33027-4993
US

IV. Provider business mailing address

5234 SW 159TH AVE
MIRAMAR FL
33027-4993
US

V. Phone/Fax

Practice location:
  • Phone: 954-701-7500
  • Fax:
Mailing address:
  • Phone: 954-701-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY ALEXANDRA GONZALEZ
Title or Position: MGR
Credential: OTR/L
Phone: 954-701-7500