Provider Demographics
NPI:1790949519
Name:KIDS OT TO PLAY, LLC
Entity Type:Organization
Organization Name:KIDS OT TO PLAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LENA
Authorized Official - Middle Name:C
Authorized Official - Last Name:WINSTON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:978-777-1122
Mailing Address - Street 1:10 ELM ST
Mailing Address - Street 2:DANVERS ATRIUM, LOWER LEVEL
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2824
Mailing Address - Country:US
Mailing Address - Phone:978-777-1122
Mailing Address - Fax:978-777-2007
Practice Address - Street 1:10 ELM ST
Practice Address - Street 2:DANVERS ATRIUM, LOWER LEVEL
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2824
Practice Address - Country:US
Practice Address - Phone:978-777-1122
Practice Address - Fax:978-777-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty