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General NPI Number Information
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NPI Number | 1629778386
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Entity Type | Organization
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Legal Business Name | PLAYBOX PEDIATRIC THERAPY
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Dates
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Enumeration Date | 03/09/2023
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | 12036 64TH AVE S
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City | SEATTLE
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State | WA
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Zip | 98178-3603
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Country | US
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Telephone | 206-785-5898
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Fax |
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Provider Business Mailing Address
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Address Line | 12036 64TH AVE S
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City | SEATTLE
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State | WA
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Zip | 98178-3603
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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 | SPEECH-LANGUAGE PATHOLOGIST
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Name | SHELLY GRACE MARIANO
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Credential | MSED, CCC-SLP
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Telephone | 206-785-5898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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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 | 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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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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