Provider Demographics
NPI:1316476849
Name:OT PLAYWORKS INC.
Entity type:Organization
Organization Name:OT PLAYWORKS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:HOSTETTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSOTR/L
Authorized Official - Phone:618-895-4260
Mailing Address - Street 1:1023 US HIGHWAY 45
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62837-2909
Mailing Address - Country:US
Mailing Address - Phone:618-895-4260
Mailing Address - Fax:618-551-8835
Practice Address - Street 1:1023 US HIGHWAY 45
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IL
Practice Address - Zip Code:62837-2909
Practice Address - Country:US
Practice Address - Phone:618-895-4260
Practice Address - Fax:618-551-8835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056008112252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency