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General NPI Number Information
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NPI Number | 1891229985
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Entity Type | Organization
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Legal Business Name | PREMAPLAY LLC
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Dates
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Enumeration Date | 04/14/2017
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Last Update Date | 04/14/2017
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Provider Practice Location Address
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Address Line | 541 ONE CENTER BLVD APT 303
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-2216
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Country | US
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Telephone | 574-807-5135
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Fax |
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Provider Business Mailing Address
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Address Line | 541 ONE CENTER BLVD APT 303
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-2216
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Country | US
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Telephone | 574-807-5135
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Fax |
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Authorized Official
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Title or Position | INDEPENDENT CONTRACTOR
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Name | BRIANNA MCCONNELL
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Credential | COTA/L
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Telephone | 574-807-5135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 15872
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License Number State | FL
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