Healthcare Provider Details

I. General information

NPI: 1851679054
Provider Name (Legal Business Name): PLAY TIME THERAPEUTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2011
Last Update Date: 07/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 N BRYAN RD STE 106
MISSION TX
78572-6293
US

IV. Provider business mailing address

409 N BRYAN RD STE 106
MISSION TX
78572-6293
US

V. Phone/Fax

Practice location:
  • Phone: 956-600-7137
  • Fax: 956-600-7139
Mailing address:
  • Phone: 956-600-7137
  • Fax: 956-600-7139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: BETTY M KELLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 956-648-0968