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General NPI Number Information
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NPI Number | 1205642774
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Entity Type | Organization
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Legal Business Name | PLAYDATES. SOFT INDOOR PLAYLOUNGE
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 2092 OMEGA RD STE G
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City | SAN RAMON
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State | CA
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Zip | 94583-1230
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Country | US
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Telephone | 415-637-7616
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Fax |
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Provider Business Mailing Address
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Address Line | 1210 ACACIA DR
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City | HAYWARD
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State | CA
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Zip | 94541-5205
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Country | US
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Telephone | 415-637-7616
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACQUELINE BUTLER
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Credential | EDUCATION SPECIALIST
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Telephone | 415-637-7616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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