Provider Demographics
NPI:1851550610
Name:KIDZ PLAY, LLC
Entity Type:Organization
Organization Name:KIDZ PLAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LEAD THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:SCHUELER
Authorized Official - Last Name:JARRARD
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:843-568-4786
Mailing Address - Street 1:1045 MATHIS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-2616
Mailing Address - Country:US
Mailing Address - Phone:843-568-4786
Mailing Address - Fax:
Practice Address - Street 1:1045 MATHIS FERRY RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-2616
Practice Address - Country:US
Practice Address - Phone:843-568-4786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2776225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1529Medicaid
SCQ33535Medicare UPIN