Healthcare Provider Details

I. General information

NPI: 1851078083
Provider Name (Legal Business Name): PURPOSEFUL PLAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 PINE GROVE AVE
PORT HURON MI
48060-3119
US

IV. Provider business mailing address

1703 PINE GROVE AVE
PORT HURON MI
48060-3119
US

V. Phone/Fax

Practice location:
  • Phone: 810-339-0027
  • Fax:
Mailing address:
  • Phone: 810-339-0027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JANIENE DENOMME
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 810-434-6006