Provider Demographics
NPI:1861669087
Name:INTERACTIVE PLAYGROUND & WELLNESS CENTER
Entity Type:Organization
Organization Name:INTERACTIVE PLAYGROUND & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUSPATIONAL THERAPIST/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:732-761-1212
Mailing Address - Street 1:20 GIBSON PL STE 301
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-4837
Mailing Address - Country:US
Mailing Address - Phone:732-761-1212
Mailing Address - Fax:732-761-1216
Practice Address - Street 1:20 GIBSON PL STE 301
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-4837
Practice Address - Country:US
Practice Address - Phone:732-761-1212
Practice Address - Fax:732-761-1216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency