Provider Demographics
NPI:1093051666
Name:GROW THRU PLAY, LLC
Entity Type:Organization
Organization Name:GROW THRU PLAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:215-545-0320
Mailing Address - Street 1:860 N BAMBREY ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-1825
Mailing Address - Country:US
Mailing Address - Phone:215-545-0320
Mailing Address - Fax:215-545-0260
Practice Address - Street 1:1638 SOUTH ST UNIT 9
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1542
Practice Address - Country:US
Practice Address - Phone:215-545-0320
Practice Address - Fax:215-545-0260
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GROW THRU PLAY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-29
Last Update Date:2012-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008357261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center