Organization
PEDIATRIC THERAPLAY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER LYNNE SPENCER OTR (OCCUPATIONAL THERAPIST)
(817) 676-1793
Entity
Organization
Contact information
Practice address
2401 IRA E WOODS AVE, SUITE 300, GRAPEVINE, TX 76051-3997
(817) 676-1793
(817) 428-6922
Mailing address
8308 REGENCY DR, NORTH RICHLAND HILLS, TX 76180-1490
(817) 676-1793
(817) 428-6922
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
111332
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003NN
BCBS GROUP ID
TX
01
—
8T6270
BCBS PIN
TX
01
—
9407121
PHCS PIN
TX
Enumeration date
12/28/2006
Last updated
08/22/2020
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