MEDICARE: PLAYTIME SOLUTIONS DEVELOPMENTAL THERAPY, PLLC

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	:	1093573065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAYTIME SOLUTIONS DEVELOPMENTAL THERAPY, PLLC

Provider Business Mailing Address
First Line	:	3425 OAK GROVE AVE
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-1856
Country	:	US
Telephone Number	:	815-222-6639
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 OAK GROVE AVE
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-1856
Country	:	US
Telephone Number	:	815-222-6639
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. EMILY DYSON
Credential	:
Telephone Number	:	815-222-6639

Provider Enumeration Date	:	03/13/2024
Last Update Date	:	06/06/2024

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