Provider Demographics
NPI:1972922821
Name:PREMAPLAY LLC
Entity type:Organization
Organization Name:PREMAPLAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-790-5601
Mailing Address - Street 1:465 S. ORLANDO AVE
Mailing Address - Street 2:#320
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751
Mailing Address - Country:US
Mailing Address - Phone:407-790-5601
Mailing Address - Fax:407-602-7858
Practice Address - Street 1:800 WESTWOOD SQ. SUITE D
Practice Address - Street 2:W. HWY 426
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765
Practice Address - Country:US
Practice Address - Phone:407-790-5601
Practice Address - Fax:407-602-7858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15041225X00000X, 225XP0200X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013653800Medicaid
FL004624400Medicaid