Healthcare Provider Details

I. General information

NPI: 1912896275
Provider Name (Legal Business Name): PLAYLAB COLLECTIVE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 S 76TH ST
GREENDALE WI
53129-1102
US

IV. Provider business mailing address

2335 S GREEN BAY RD
RACINE WI
53406-4921
US

V. Phone/Fax

Practice location:
  • Phone: 262-497-7270
  • Fax: 877-540-0135
Mailing address:
  • Phone: 262-497-7270
  • Fax: 877-540-0135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: TAMMY MYERS
Title or Position: OWNER
Credential: MS CCC SLP
Phone: 262-721-7357