Provider Demographics
NPI:1598466021
Name:PLAY BY PLAY PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:PLAY BY PLAY PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LEWIN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:920-810-0523
Mailing Address - Street 1:2237 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4826
Mailing Address - Country:US
Mailing Address - Phone:920-810-0523
Mailing Address - Fax:
Practice Address - Street 1:2237 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4826
Practice Address - Country:US
Practice Address - Phone:920-810-0523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty