Provider Demographics
NPI:1215371612
Name:LET'S PLAY PEDIATRIC THERAPY SERVICES, PLLC
Entity Type:Organization
Organization Name:LET'S PLAY PEDIATRIC THERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:518-542-1027
Mailing Address - Street 1:6304 KIT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-9353
Mailing Address - Country:US
Mailing Address - Phone:518-542-1027
Mailing Address - Fax:919-544-5514
Practice Address - Street 1:6304 KIT CREEK RD
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-9353
Practice Address - Country:US
Practice Address - Phone:518-542-1027
Practice Address - Fax:919-544-5514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4928225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301605Medicaid