Provider Demographics
NPI:1538418652
Name:ANGEL'S PLAY LLC
Entity type:Organization
Organization Name:ANGEL'S PLAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR/L
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HUTTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-507-0354
Mailing Address - Street 1:PO BOX 5051
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29804-5051
Mailing Address - Country:US
Mailing Address - Phone:803-507-0354
Mailing Address - Fax:803-649-2054
Practice Address - Street 1:1506 WHISKEY RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-5312
Practice Address - Country:US
Practice Address - Phone:803-507-0354
Practice Address - Fax:803-649-2054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC701225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1025Medicaid