MEDICARE: PLAY ALL DAY PEDIATRIC THERAPY LLC

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	103K00000X	Behavior Analyst
2	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1124721998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAY ALL DAY PEDIATRIC THERAPY LLC

Provider Business Mailing Address
First Line	:	101 CHAPEL GROVE CT
Second Line	:
City	:	WENTZVILLE
State	:	MO
Zip	:	63385-4339
Country	:	US
Telephone Number	:	636-443-5379
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 BOARDWALK SPRINGS PL STE 107
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63368-4778
Country	:	US
Telephone Number	:	636-443-5379
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	TRINA NICOLE BLACKWOOD
Credential	:	MOTR/L
Telephone Number	:	636-443-5379

Provider Enumeration Date	:	03/22/2023
Last Update Date	:	06/06/2023

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