=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366163263
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLAY TO THRIVE INTERVENTION SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2022
-----------------------------------------------------
Last Update Date | 09/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4001 RAPHUNE HILL RD UNIT 206
-----------------------------------------------------
City | ST THOMAS
-----------------------------------------------------
State | VI
-----------------------------------------------------
Zip | 00802-2905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 340-727-7529
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4001 RAPHUNE HILL RD UNIT 206
-----------------------------------------------------
City | ST THOMAS
-----------------------------------------------------
State | VI
-----------------------------------------------------
Zip | 00802-2905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 340-727-7529
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. ADRIENNE DOOLEY
-----------------------------------------------------
Credential | M.S., CCC-SLP
-----------------------------------------------------
Telephone | 781-266-7608
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------