Organization
KIDSPLAY THERAPY CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRETCHEN R. CLARK OTR/L (CEO, OWNER)
(678) 205-5437
Entity
Organization
Contact information
Practice address
311 COOPER ROAD, LOGANVILLE, GA 30052-4976
(678) 205-5437
(678) 377-7950
Mailing address
311 COOPER ROAD, LOGANVILLE, GA 30052-4976
(678) 205-5437
(678) 377-7950
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
037896932A
—
GA
Enumeration date
11/01/2006
Last updated
10/19/2012
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