Healthcare Provider Details

I. General information

NPI: 1396491536
Provider Name (Legal Business Name): TAMPA PLAY THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1649 DAVENPORT DR
NEW PORT RICHEY FL
34655-4231
US

IV. Provider business mailing address

1649 DAVENPORT DR
NEW PORT RICHEY FL
34655-4231
US

V. Phone/Fax

Practice location:
  • Phone: 727-277-6812
  • Fax: 727-375-1743
Mailing address:
  • Phone: 727-277-6812
  • Fax: 727-375-1743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNA RABER
Title or Position: OWNER
Credential: OTD, OTR/L
Phone: 727-277-6812