Healthcare Provider Details

I. General information

NPI: 1962920660
Provider Name (Legal Business Name): FUNCTIONAL INTERPLAY THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 CENTRAL PARKWAY SUITE 300
CINCINNATI OH
45214
US

IV. Provider business mailing address

2145 CENTRAL PARKWAY SUITE 300
CINCINNATI OH
45214
US

V. Phone/Fax

Practice location:
  • Phone: 513-910-9465
  • Fax:
Mailing address:
  • Phone: 513-910-9465
  • Fax: 513-721-7529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberOT.008579
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. ANGELINA MARY VITUCCI
Title or Position: OWNER/OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 513-910-9465