Provider Demographics
NPI:1881750461
Name:PEDIATRIC THERAPLAY INC
Entity type:Organization
Organization Name:PEDIATRIC THERAPLAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:817-676-1793
Mailing Address - Street 1:8308 REGENCY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-1490
Mailing Address - Country:US
Mailing Address - Phone:817-676-1793
Mailing Address - Fax:817-428-6922
Practice Address - Street 1:2401 IRA E WOODS AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3997
Practice Address - Country:US
Practice Address - Phone:817-676-1793
Practice Address - Fax:817-428-6922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111332225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0003NNOtherBCBS GROUP ID
TX8T6270OtherBCBS PIN
TX9407121OtherPHCS PIN