Provider Demographics
NPI:1811745144
Name:PLAYFUL MINDS PEDIATRIC THERAPY, LLC
Entity type:Organization
Organization Name:PLAYFUL MINDS PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:770-362-6079
Mailing Address - Street 1:11373 OAK ALLEY DR S
Mailing Address - Street 2:
Mailing Address - City:GRAND BAY
Mailing Address - State:AL
Mailing Address - Zip Code:36541-4489
Mailing Address - Country:US
Mailing Address - Phone:770-362-6079
Mailing Address - Fax:251-252-0367
Practice Address - Street 1:11373 OAK ALLEY DR S
Practice Address - Street 2:
Practice Address - City:GRAND BAY
Practice Address - State:AL
Practice Address - Zip Code:36541-4489
Practice Address - Country:US
Practice Address - Phone:770-362-6079
Practice Address - Fax:251-252-0367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty