Provider Demographics
NPI:1851078083
Name:PURPOSEFUL PLAY LLC
Entity type:Organization
Organization Name:PURPOSEFUL PLAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JANIENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DENOMME
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:810-434-6006
Mailing Address - Street 1:1703 PINE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3119
Mailing Address - Country:US
Mailing Address - Phone:810-339-0027
Mailing Address - Fax:
Practice Address - Street 1:1703 PINE GROVE AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3119
Practice Address - Country:US
Practice Address - Phone:810-339-0027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty