Provider Demographics
NPI:1396960829
Name:CHILD'S PLAY THERAPY SERVICES, INC.
Entity type:Organization
Organization Name:CHILD'S PLAY THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENSE
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:479-220-0756
Mailing Address - Street 1:19 BILLINGSLEY DR
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-5542
Mailing Address - Country:US
Mailing Address - Phone:479-220-0756
Mailing Address - Fax:
Practice Address - Street 1:19 BILLINGSLEY DR
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72714-5542
Practice Address - Country:US
Practice Address - Phone:479-220-0756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1669225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty