1033501655 NPI number — PLAYWORKS OCCUPATIONAL THERAPY, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033501655 NPI number — PLAYWORKS OCCUPATIONAL THERAPY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLAYWORKS OCCUPATIONAL THERAPY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033501655
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3050 N NAVAJO DR
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
PRESCOTT VALLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86314-8663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-771-9327
Provider Business Mailing Address Fax Number:
928-771-9519

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3050 N NAVAJO DR
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
PRESCOTT VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86314-8663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-771-9327
Provider Business Practice Location Address Fax Number:
928-771-9519
Provider Enumeration Date:
02/19/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BARNETT
Authorized Official First Name:
ANITA
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE MANAGER
Authorized Official Telephone Number:
928-771-9327

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , with the licence number:  5397 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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