Healthcare Provider Details

I. General information

NPI: 1063135044
Provider Name (Legal Business Name): PLAY BY THE BAY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 SURRY RD
VIRGINIA BEACH VA
23455-1624
US

IV. Provider business mailing address

3808 SURRY RD
VIRGINIA BEACH VA
23455-1624
US

V. Phone/Fax

Practice location:
  • Phone: 410-713-0176
  • Fax: 757-578-8656
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: LAUREN HAYES CLARK
Title or Position: OWNER/SPEECH PATHOLOGIST
Credential: M.S. CCC-SLP
Phone: 410-713-0176