Healthcare Provider Details

I. General information

NPI: 1629778386
Provider Name (Legal Business Name): PLAYBOX PEDIATRIC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12036 64TH AVE S
SEATTLE WA
98178-3603
US

IV. Provider business mailing address

12036 64TH AVE S
SEATTLE WA
98178-3603
US

V. Phone/Fax

Practice location:
  • Phone: 206-785-5898
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: SHELLY GRACE MARIANO
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: MSED, CCC-SLP
Phone: 206-785-5898