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General NPI Number Information
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NPI Number | 1649611096
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Entity Type | Organization
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Legal Business Name | PLAYFUL DEVELOPMENT, LLC
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 07/15/2013
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Provider Practice Location Address
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Address Line | 547 MAIN ST
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City | SOUTH GLASTONBURY
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State | CT
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Zip | 06073-3120
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Country | US
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Telephone | 860-657-3454
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Fax | 860-657-8680
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Provider Business Mailing Address
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Address Line | 547 MAIN ST
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City | SOUTH GLASTONBURY
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State | CT
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Zip | 06073-3120
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Country | US
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Telephone | 860-657-3454
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Fax | 860-657-8680
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Authorized Official
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Title or Position | OWNER/PEDIATRIC OCCUPATIONAL THERAP
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Name | MRS. DONNA STEFANO
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Credential | O.T.R.
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Telephone | 860-657-3454
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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 | 002485
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License Number State | CT
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