Healthcare Provider Details

I. General information

NPI: 1336687466
Provider Name (Legal Business Name): THERAPLAY LEARNING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 N STATE ST
NORTON KS
67654-2046
US

IV. Provider business mailing address

113 N STATE ST
NORTON KS
67654-2046
US

V. Phone/Fax

Practice location:
  • Phone: 785-871-7987
  • Fax:
Mailing address:
  • Phone: 785-871-7987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-00568
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17-1896
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17-00519
License Number StateKS

VIII. Authorized Official

Name: RENEE MILLER
Title or Position: PARTNER
Credential: OTR/L
Phone: 785-871-7987