Provider Demographics
NPI:1477987337
Name:PLAY & GROW THERAPY, LLC
Entity Type:Organization
Organization Name:PLAY & GROW THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ITZEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:915-408-7198
Mailing Address - Street 1:2808 MAGIC ROCK DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-4551
Mailing Address - Country:US
Mailing Address - Phone:915-408-7198
Mailing Address - Fax:
Practice Address - Street 1:1445 BESSEMER DR
Practice Address - Street 2:SUITE C
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5930
Practice Address - Country:US
Practice Address - Phone:915-408-7198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Single Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty