Provider Demographics
NPI:1902993975
Name:PLAYMATE THERAPY SERVICES, INC
Entity Type:Organization
Organization Name:PLAYMATE THERAPY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:678-598-2095
Mailing Address - Street 1:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-0655
Mailing Address - Country:US
Mailing Address - Phone:678-598-2095
Mailing Address - Fax:678-669-2652
Practice Address - Street 1:1464 ALICE AVE
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-3241
Practice Address - Country:US
Practice Address - Phone:678-598-2095
Practice Address - Fax:678-669-2652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003666251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000981406CMedicaid
GA10061625OtherAMERIGROUP