Healthcare Provider Details

I. General information

NPI: 1770819385
Provider Name (Legal Business Name): KIDS AT PLAY THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16501 64TH ST E STE D
SUMNER WA
98390-3001
US

IV. Provider business mailing address

16501 64TH ST E STE D
SUMNER WA
98390-3001
US

V. Phone/Fax

Practice location:
  • Phone: 253-447-8216
  • Fax: 253-447-8789
Mailing address:
  • Phone: 253-447-8216
  • Fax: 253-447-8789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number602939253
License Number StateWA

VIII. Authorized Official

Name: MRS. TANYA L O'CALLAGHAN
Title or Position: OWNER
Credential:
Phone: 253-447-8216