Healthcare Provider Details

I. General information

NPI: 1124721998
Provider Name (Legal Business Name): PLAY ALL DAY PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BOARDWALK SPRINGS PL STE 107
O FALLON MO
63368-4778
US

IV. Provider business mailing address

101 CHAPEL GROVE CT
WENTZVILLE MO
63385-4339
US

V. Phone/Fax

Practice location:
  • Phone: 636-443-5379
  • Fax:
Mailing address:
  • Phone: 636-443-5379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: TRINA NICOLE BLACKWOOD
Title or Position: OCCUPATIONAL THERAPIST
Credential: MOTR/L
Phone: 636-443-5379