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General NPI Number Information
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NPI Number | 1710585823
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Entity Type | Organization
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Legal Business Name | PURPOSEFUL PLAY PEDIATRIC THERAPY SERVICES, PLLC
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Dates
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Enumeration Date | 10/12/2020
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Last Update Date | 10/12/2020
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Provider Practice Location Address
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Address Line | 657 SELF HOLLOW RD
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City | ROCKFORD
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State | TN
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Zip | 37853
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Country | US
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Telephone | 865-963-5569
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Fax |
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Provider Business Mailing Address
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Address Line | 103 S PINE ST
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City | MARYVILLE
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State | TN
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Zip | 37804-5102
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Country | US
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Telephone | 815-793-6009
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Fax |
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Authorized Official
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Title or Position | SLP/OWNER
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Name | MICHELLE PRACH
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Credential | MS, CCC-SLP
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Telephone | 865-963-5569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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