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General NPI Number Information
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NPI Number | 1881053122
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Entity Type | Organization
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Legal Business Name | PLAY 2 GROW THERAPY
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Dates
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Enumeration Date | 02/15/2016
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Last Update Date | 02/15/2016
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Provider Practice Location Address
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Address Line | 314 EAST COUNTRY DRIVE
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City | BARTLETT
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State | IL
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Zip | 60103-8912
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Country | US
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Telephone | 630-973-3152
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Fax |
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Provider Business Mailing Address
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Address Line | 314 EAST COUNTRY DRIVE
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City | BARTLETT
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State | IL
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Zip | 60103-8912
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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 | PRESIDENT
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Name | KATHLEEN MARINO
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Credential |
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Telephone | 630-973-3152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number | KM61620612P
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License Number State | IL
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