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General NPI Number Information
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NPI Number | 1679695381
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Entity Type | Organization
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Legal Business Name | PEDIPLAY LLC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 08/19/2013
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Provider Practice Location Address
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Address Line | 6239 S EAST ST SUITE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-2090
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Country | US
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Telephone | 317-791-9031
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Fax | 317-791-9001
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Provider Business Mailing Address
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Address Line | 6239 S EAST ST SUITE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-2090
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Country | US
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Telephone | 317-791-9031
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Fax | 317-791-9001
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Authorized Official
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Title or Position | OWNER
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Name | MS. BARBARA P BLAIN
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Credential | OTR
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Telephone | 317-791-9031
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 31001006 A
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License Number State | IN
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