Provider Demographics
NPI:1275268005
Name:THE PEDIATRIC PLAYHOUSE
Entity Type:Organization
Organization Name:THE PEDIATRIC PLAYHOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:AKIN
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:479-858-2216
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72858-0010
Mailing Address - Country:US
Mailing Address - Phone:479-858-2216
Mailing Address - Fax:
Practice Address - Street 1:701 E MAIN ST STE 16
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-5209
Practice Address - Country:US
Practice Address - Phone:479-858-2216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-16
Last Update Date:2022-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty