Healthcare Provider Details

I. General information

NPI: 1679695381
Provider Name (Legal Business Name): PEDIPLAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6239 S EAST ST SUITE A
INDIANAPOLIS IN
46227-2090
US

IV. Provider business mailing address

6239 S EAST ST SUITE A
INDIANAPOLIS IN
46227-2090
US

V. Phone/Fax

Practice location:
  • Phone: 317-791-9031
  • Fax: 317-791-9001
Mailing address:
  • Phone: 317-791-9031
  • Fax: 317-791-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31001006 A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. BARBARA P BLAIN
Title or Position: OWNER
Credential: OTR
Phone: 317-791-9031