Provider Demographics
NPI:1386286920
Name:OCCUPATIONAL PLAY
Entity type:Organization
Organization Name:OCCUPATIONAL PLAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIERSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:908-472-5099
Mailing Address - Street 1:423 GOODWICK DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-0188
Mailing Address - Country:US
Mailing Address - Phone:908-472-5099
Mailing Address - Fax:
Practice Address - Street 1:423 GOODWICK DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-0188
Practice Address - Country:US
Practice Address - Phone:908-472-5099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty