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General NPI Number Information
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NPI Number | 1093051666
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Entity Type | Organization
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Legal Business Name | GROW THRU PLAY, LLC
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Dates
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Enumeration Date | 12/29/2012
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Last Update Date | 12/29/2012
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Provider Practice Location Address
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Address Line | 1638 SOUTH ST UNIT 9
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City | PHILADELPHIA
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State | PA
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Zip | 19146-1542
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Country | US
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Telephone | 215-545-0320
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Fax | 215-545-0260
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Provider Business Mailing Address
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Address Line | 860 N BAMBREY ST
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City | PHILADELPHIA
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State | PA
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Zip | 19130-1825
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Country | US
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Telephone | 215-545-0320
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Fax | 215-545-0260
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Authorized Official
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Title or Position | OWNER/OCCUPATIONAL THERAPIST
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Name | MS. TARA MARTELLO
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Credential | M.S., OTR/L
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Telephone | 215-545-0320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | OC008357
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License Number State | PA
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