Healthcare Provider Details

I. General information

NPI: 1174199350
Provider Name (Legal Business Name): URBANPLAY INNOVATIVE OT, PPLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 WILLOWBEND RD
ROCHESTER NY
14618-4050
US

IV. Provider business mailing address

270 WILLOWBEND RD
ROCHESTER NY
14618-4050
US

V. Phone/Fax

Practice location:
  • Phone: 585-305-5312
  • Fax:
Mailing address:
  • Phone: 585-305-5312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. LEORA ROZIN
Title or Position: OWNER
Credential: OT/L, PMH-C
Phone: 585-305-5312