Provider Demographics
NPI:1760753545
Name:KIDZ AT PLAY THERAPY, PLLC
Entity Type:Organization
Organization Name:KIDZ AT PLAY THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:LITTLE
Authorized Official - Last Name:HYLTON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L/BS
Authorized Official - Phone:276-780-3374
Mailing Address - Street 1:927 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4117
Mailing Address - Country:US
Mailing Address - Phone:276-783-7529
Mailing Address - Fax:276-783-7555
Practice Address - Street 1:927 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4117
Practice Address - Country:US
Practice Address - Phone:276-783-7529
Practice Address - Fax:276-783-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Z00000X, 225200000X
VA0119003180252Y00000X, 261QR0400X
VA2202006031252Y00000X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency