Provider Demographics
NPI:1508639683
Name:PURPOSEFUL PLAY LLC
Entity Type:Organization
Organization Name:PURPOSEFUL PLAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ERICKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:414-573-7851
Mailing Address - Street 1:4380 67TH DR
Mailing Address - Street 2:
Mailing Address - City:UNION GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53182-9338
Mailing Address - Country:US
Mailing Address - Phone:414-573-7851
Mailing Address - Fax:
Practice Address - Street 1:4380 67TH DR
Practice Address - Street 2:
Practice Address - City:UNION GROVE
Practice Address - State:WI
Practice Address - Zip Code:53182-9338
Practice Address - Country:US
Practice Address - Phone:414-573-7851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty