Organization
THERA - PLAY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY SEAN SHIRLEY OTA/L (OWNER/CEO/THERAPIST)
(386) 405-6586
Entity
Organization
Contact information
Practice address
109 CAPRI DR, ORMOND BEACH, FL 32176-2233
(386) 405-6586
Mailing address
109 CAPRI DR, ORMOND BEACH, FL 32176-2233
(386) 405-6586
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT11104
FL
235Z00000X
Speech-Language Pathologist
10889
FL
Other
Enumeration date
11/28/2016
Last updated
11/28/2016
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