Provider Demographics
NPI:1811238629
Name:PLAYTIME PEDIATRIC OCCUPATIONAL THERAPY
Entity Type:Organization
Organization Name:PLAYTIME PEDIATRIC OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MOTR/L
Authorized Official - Phone:270-475-7003
Mailing Address - Street 1:1155 MASON LN
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:KY
Mailing Address - Zip Code:42266-8620
Mailing Address - Country:US
Mailing Address - Phone:270-475-7003
Mailing Address - Fax:270-475-7003
Practice Address - Street 1:1155 MASON LN
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:KY
Practice Address - Zip Code:42266-8620
Practice Address - Country:US
Practice Address - Phone:270-475-7003
Practice Address - Fax:270-475-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR4363252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency