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General NPI Number Information
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NPI Number | 1124721998
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Entity Type | Organization
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Legal Business Name | PLAY ALL DAY PEDIATRIC THERAPY LLC
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Dates
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Enumeration Date | 03/22/2023
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 1001 BOARDWALK SPRINGS PL STE 107
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City | O FALLON
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State | MO
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Zip | 63368-4778
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Country | US
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Telephone | 636-443-5379
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Fax |
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Provider Business Mailing Address
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Address Line | 101 CHAPEL GROVE CT
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City | WENTZVILLE
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State | MO
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Zip | 63385-4339
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Country | US
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Telephone | 636-443-5379
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | TRINA NICOLE BLACKWOOD
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Credential | MOTR/L
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Telephone | 636-443-5379
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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