1811190283 NPI number — THERAPLAY @ HOME

Table of content: (NPI 1811190283)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811190283 NPI number — THERAPLAY @ HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPLAY @ HOME
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:
1811190283
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
914 S HILLSIDE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67211-4001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-284-0371
Provider Business Mailing Address Fax Number:
407-233-1190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1335 LONGHILL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APOPKA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32712-2430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-284-0371
Provider Business Practice Location Address Fax Number:
321-256-2313
Provider Enumeration Date:
06/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DICKINSON
Authorized Official First Name:
KRISTINE
Authorized Official Middle Name:
KARBAN
Authorized Official Title or Position:
DIRECTOR OF THERAPY
Authorized Official Telephone Number:
407-284-0371

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X , with the licence number: OT4485 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 888091300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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