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General NPI Number Information
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NPI Number | 1457067910
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Entity Type | Organization
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Legal Business Name | JUSTPLAY PEDIATRIC THERAPY AND CHILDREN'S PLAY SPACE LLC
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Dates
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Enumeration Date | 01/27/2023
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Last Update Date | 01/27/2023
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Provider Practice Location Address
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Address Line | 4214 CHESAPEAKE DR APT 2D
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City | AURORA
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State | IL
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Zip | 60504-5134
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Country | US
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Telephone | 815-823-7208
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Fax |
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Provider Business Mailing Address
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Address Line | 4214 CHESAPEAKE DR APT 2D
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City | AURORA
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State | IL
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Zip | 60504-5134
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Country | US
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Telephone | 815-823-7208
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Fax |
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Authorized Official
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Title or Position | OWNER/OCCUPATIONAL THERAPIST
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Name | DR. MARQUIE R PRICE
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Credential | OTD
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Telephone | 815-823-7208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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Taxonomy #5
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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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