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General NPI Number Information
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NPI Number | 1730066960
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Entity Type | Organization
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Legal Business Name | PEDIATRIC PLAY THERAPY
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Dates
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Enumeration Date | 08/19/2025
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 2109 OTOOLE AVE STE M
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City | SAN JOSE
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State | CA
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Zip | 95131-1338
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Country | US
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Telephone | 408-573-7720
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Fax |
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Provider Business Mailing Address
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Address Line | 2109 OTOOLE AVE STE M
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City | SAN JOSE
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State | CA
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Zip | 95131-1338
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Country | US
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Telephone | 408-573-7720
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. SUE M HENRY
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Credential | OT #1899
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Telephone | 408-218-4136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XF0002X
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Taxonomy Name | Feeding, Eating & Swallowing 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 | 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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