Provider Demographics
NPI:1215670393
Name:KIDS N' PLAY OCCUPATIONAL THERAPY
Entity type:Organization
Organization Name:KIDS N' PLAY OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KYNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OT R/L
Authorized Official - Phone:267-270-1987
Mailing Address - Street 1:511 DEMBYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-4108
Mailing Address - Country:US
Mailing Address - Phone:267-270-1987
Mailing Address - Fax:
Practice Address - Street 1:511 DEMBYTOWN RD
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-4108
Practice Address - Country:US
Practice Address - Phone:267-270-1987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD480019200Medicaid