MEDICARE: PLAY-BASED WELLNESS BEHAVIORAL HEALTH PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225XP0200X	Pediatric Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1003672080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAY-BASED WELLNESS BEHAVIORAL HEALTH PLLC

Provider Business Mailing Address
First Line	:	208 N ALLEN HEIGHTS DR
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75002-2316
Country	:	US
Telephone Number	:	773-726-0773
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 N BROOKSIDE DR APT 1315
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-7519
Country	:	US
Telephone Number	:	773-726-0773
Fax Number	:

Authorized Official
Title or Position	:	FOUNDING CLINICIAN
Name	:	ANNA OSIPOVA
Credential	:	BCBA
Telephone Number	:	773-726-0773

Provider Enumeration Date	:	02/26/2024
Last Update Date	:	02/24/2026

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