Provider Demographics
NPI:1669529871
Name:PLAYWORKS CENTER FOR DEVELOPMENT AND LEARNING, INC.
Entity type:Organization
Organization Name:PLAYWORKS CENTER FOR DEVELOPMENT AND LEARNING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/SPEECH/LANGUAGE PATHOLOGIS
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WILMS
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:909-792-0543
Mailing Address - Street 1:112 11TH ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-3566
Mailing Address - Country:US
Mailing Address - Phone:909-792-0543
Mailing Address - Fax:909-792-0546
Practice Address - Street 1:112 11TH ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-3566
Practice Address - Country:US
Practice Address - Phone:909-792-0543
Practice Address - Fax:909-792-0546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT6314225XP0200X
CASP10010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty