Organization
PURPOSEFUL PLAY PEDIATRIC THERAPY SERVICES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE PRACH MS, CCC-SLP (SLP/OWNER)
(865) 963-5569
Entity
Organization
Contact information
Practice address
657 SELF HOLLOW RD, ROCKFORD, TN 37853
(865) 963-5569
Mailing address
103 S PINE ST, MARYVILLE, TN 37804-5102
(815) 793-6009
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q058420
—
TN
Enumeration date
10/12/2020
Last updated
10/12/2020
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