Provider Demographics
NPI:1669522314
Name:THERAPLAYCE CHILDREN'S DEVELOPMENT CENTER
Entity type:Organization
Organization Name:THERAPLAYCE CHILDREN'S DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MONESTERO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:402-731-8888
Mailing Address - Street 1:4930 L ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68117-1553
Mailing Address - Country:US
Mailing Address - Phone:402-731-8888
Mailing Address - Fax:402-731-8090
Practice Address - Street 1:4930 L ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68117-1553
Practice Address - Country:US
Practice Address - Phone:402-731-8888
Practice Address - Fax:402-731-8090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE682225100000X
NE181225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE95488OtherCOVENTRY HEALTH CARE OF NEBRASKA
NE86841OtherMUTUAL OF OMAHA
NE6400111OtherUNITED HEALTHCARE INSURAN
NE6400111OtherUNITED HEALTHCARE INSURAN