Healthcare Provider Details

I. General information

NPI: 1871106286
Provider Name (Legal Business Name): THERAPLAY PEDIATRIC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 N BUTLER AVE STE 2212
FARMINGTON NM
87401-5621
US

IV. Provider business mailing address

3300 N BUTLER AVE STE 212
FARMINGTON NM
87401-2362
US

V. Phone/Fax

Practice location:
  • Phone: 505-716-8075
  • Fax:
Mailing address:
  • Phone: 505-716-8075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRITTANY KAY PARKER
Title or Position: OWNER
Credential: OTD, OTR/L
Phone: 505-716-3060