MEDICARE: PLAY AND POTENTIAL 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	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1982452876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAY AND POTENTIAL LLC

Provider Business Mailing Address
First Line	:	7122 BRIGHTON VILLAGE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-7101
Country	:	US
Telephone Number	:	716-380-2292
Fax Number	:	716-380-2292

Provider Business Practice Location Address
First Line	:	7122 BRIGHTON VILLAGE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-7101
Country	:	US
Telephone Number	:	716-380-2292
Fax Number	:	716-380-2292

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	SILJA CHRISTIAN
Credential	:
Telephone Number	:	716-380-2292

Provider Enumeration Date	:	05/07/2024
Last Update Date	:	06/11/2024

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Directions to “PLAY AND POTENTIAL LLC ” Practice Location

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