Provider Demographics
NPI:1962920660
Name:FUNCTIONAL INTERPLAY THERAPY, LLC
Entity type:Organization
Organization Name:FUNCTIONAL INTERPLAY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:VITUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:513-910-9465
Mailing Address - Street 1:2145 CENTRAL PARKWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45214
Mailing Address - Country:US
Mailing Address - Phone:513-910-9465
Mailing Address - Fax:513-721-7529
Practice Address - Street 1:2145 CENTRAL PARKWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45214
Practice Address - Country:US
Practice Address - Phone:513-910-9465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-01
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
OHOT.008579261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty