Provider Demographics
NPI:1013148923
Name:THERAPLAY LLC.
Entity type:Organization
Organization Name:THERAPLAY LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:TASHA
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:919-895-2006
Mailing Address - Street 1:PO BOX 4796
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27331-4796
Mailing Address - Country:US
Mailing Address - Phone:919-895-2006
Mailing Address - Fax:919-777-2725
Practice Address - Street 1:644 BRITTON CT
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-7309
Practice Address - Country:US
Practice Address - Phone:919-895-2006
Practice Address - Fax:919-777-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7200183Medicaid