Provider Demographics
NPI:1457067910
Name:JUSTPLAY PEDIATRIC THERAPY AND CHILDREN'S PLAY SPACE LLC
Entity Type:Organization
Organization Name:JUSTPLAY PEDIATRIC THERAPY AND CHILDREN'S PLAY SPACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARQUIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:OTD
Authorized Official - Phone:815-823-7208
Mailing Address - Street 1:4214 CHESAPEAKE DR APT 2D
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-5134
Mailing Address - Country:US
Mailing Address - Phone:815-823-7208
Mailing Address - Fax:
Practice Address - Street 1:4214 CHESAPEAKE DR APT 2D
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-5134
Practice Address - Country:US
Practice Address - Phone:815-823-7208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)Group - Multi-Specialty