Healthcare Provider Details

I. General information

NPI: 1457067910
Provider Name (Legal Business Name): JUSTPLAY PEDIATRIC THERAPY AND CHILDREN'S PLAY SPACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4214 CHESAPEAKE DR APT 2D
AURORA IL
60504-5134
US

IV. Provider business mailing address

4214 CHESAPEAKE DR APT 2D
AURORA IL
60504-5134
US

V. Phone/Fax

Practice location:
  • Phone: 815-823-7208
  • Fax:
Mailing address:
  • Phone: 815-823-7208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: DR. MARQUIE R PRICE
Title or Position: OWNER/OCCUPATIONAL THERAPIST
Credential: OTD
Phone: 815-823-7208