MEDICARE: PLAY & LEARN DEVELOPMENTAL COMPANY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency
2	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1083254874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAY & LEARN DEVELOPMENTAL COMPANY

Provider Business Mailing Address
First Line	:	4518 W VAN BUREN ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60624-3050
Country	:	US
Telephone Number	:	773-750-5916
Fax Number	:

Provider Business Practice Location Address
First Line	:	4518 W VAN BUREN ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60624-3050
Country	:	US
Telephone Number	:	773-750-5916
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALYSSIA BELK
Credential	:
Telephone Number	:	773-750-5916

Provider Enumeration Date	:	01/09/2020
Last Update Date	:	10/23/2020

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Directions to “PLAY & LEARN DEVELOPMENTAL COMPANY ” Practice Location

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