=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457601379
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHILDS PLAY THERAPY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2012
-----------------------------------------------------
Last Update Date | 09/18/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3505 TYLER AVE
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-600-9584
-----------------------------------------------------
Fax | 956-631-4810
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3505 TYLER AVE
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-600-9584
-----------------------------------------------------
Fax | 956-631-4810
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. MARIA M MUNIZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-600-9584
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------