Provider Demographics
NPI:1225280027
Name:PLAYPATH THERAPY
Entity Type:Organization
Organization Name:PLAYPATH THERAPY
Other - Org Name:LARBARDO CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:PEDIATRIC OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BARDACH
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:805-481-7529
Mailing Address - Street 1:750 FARROLL RD
Mailing Address - Street 2:UNIT E
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-2654
Mailing Address - Country:US
Mailing Address - Phone:805-481-7529
Mailing Address - Fax:805-481-7529
Practice Address - Street 1:750 FARROLL RD
Practice Address - Street 2:UNIT E
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-2654
Practice Address - Country:US
Practice Address - Phone:805-481-7529
Practice Address - Fax:805-481-7529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-13
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT4352103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6292320001Medicare NSC
CA6292320001Medicare PIN