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General NPI Number Information
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NPI Number | 1598301780
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Entity Type | Organization
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Legal Business Name | PLAY TO GROW OT LLC
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Dates
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Enumeration Date | 11/22/2019
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Last Update Date | 11/22/2019
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Provider Practice Location Address
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Address Line | 214 PRINCE ST
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City | CARRBORO
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State | NC
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Zip | 27510-2218
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Country | US
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Telephone | 989-600-2497
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Fax | 501-443-1824
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Provider Business Mailing Address
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Address Line | 214 PRINCE ST
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City | CARRBORO
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State | NC
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Zip | 27510-2218
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Country | US
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Telephone | 989-600-2497
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Fax | 501-443-1824
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Authorized Official
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Title or Position | OWNER
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Name | LAUREN WAGNER
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Credential | OTR
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Telephone | 989-600-2497
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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 |
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License Number State |
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