Healthcare Provider Details

I. General information

NPI: 1902176258
Provider Name (Legal Business Name): THERAPLAY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2251 E PARIS AVE SE
GRAND RAPIDS MI
49546-2431
US

IV. Provider business mailing address

2251 EAST PARIS AVE SE
GRAND RAPIDS MI
49546-2431
US

V. Phone/Fax

Practice location:
  • Phone: 616-447-7799
  • Fax:
Mailing address:
  • Phone: 616-447-7799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5201006016
License Number StateMI

VIII. Authorized Official

Name: TERESA L COOPER
Title or Position: OWNER
Credential: MSOT
Phone: 616-447-7799