Provider Demographics
NPI:1518328137
Name:JOYFUL PLAY PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:JOYFUL PLAY PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR/L
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:JESSOP
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:720-232-0911
Mailing Address - Street 1:8082 W MASSEY CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-6233
Mailing Address - Country:US
Mailing Address - Phone:720-232-0911
Mailing Address - Fax:
Practice Address - Street 1:8082 W MASSEY CIR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-6233
Practice Address - Country:US
Practice Address - Phone:720-232-0911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002080225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO61084077Medicaid