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General NPI Number Information
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NPI Number | 1366164857
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Entity Type | Organization
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Legal Business Name | THERAPLAY JAX LLC
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Dates
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Enumeration Date | 09/13/2022
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 13475 ATLANTIC BLVD STE 8
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City | JACKSONVILLE
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State | FL
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Zip | 32225-3290
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Country | US
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Telephone | 850-982-6348
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Fax |
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Provider Business Mailing Address
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Address Line | 12925 DEEP LAGOON PL E
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City | JACKSONVILLE
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State | FL
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Zip | 32246-1048
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAURA WILSON
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Credential | MA, CCC-SLP
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Telephone | 850-982-6348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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