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General NPI Number Information
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NPI Number | 1396960829
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Entity Type | Organization
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Legal Business Name | CHILD'S PLAY THERAPY SERVICES, INC.
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 19 BILLINGSLEY DR
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City | BELLA VISTA
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State | AR
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Zip | 72714-5542
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Country | US
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Telephone | 479-220-0756
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Fax |
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Provider Business Mailing Address
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Address Line | 19 BILLINGSLEY DR
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City | BELLA VISTA
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State | AR
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Zip | 72714-5542
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Country | US
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Telephone | 479-220-0756
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GLORIA PENSE
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Credential | OT
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Telephone | 479-220-0756
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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 | 1669
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License Number State | AR
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