Provider Demographics
NPI:1811190283
Name:THERAPLAY @ HOME
Entity type:Organization
Organization Name:THERAPLAY @ HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF THERAPY
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:KARBAN
Authorized Official - Last Name:DICKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:407-284-0371
Mailing Address - Street 1:914 S HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-4001
Mailing Address - Country:US
Mailing Address - Phone:407-284-0371
Mailing Address - Fax:407-233-1190
Practice Address - Street 1:1335 LONGHILL DR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-2430
Practice Address - Country:US
Practice Address - Phone:407-284-0371
Practice Address - Fax:321-256-2313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT4485225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888091300Medicaid