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General NPI Number Information
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NPI Number | 1275268005
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Entity Type | Organization
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Legal Business Name | THE PEDIATRIC PLAYHOUSE
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Dates
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Enumeration Date | 07/16/2022
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Last Update Date | 07/16/2022
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Provider Practice Location Address
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Address Line | 701 E MAIN ST STE 16
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-5209
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Country | US
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Telephone | 479-858-2216
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10
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City | POTTSVILLE
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State | AR
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Zip | 72858-0010
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Country | US
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Telephone | 479-858-2216
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. BRANDI AKIN
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Credential | OT
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Telephone | 479-858-2216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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