Provider Demographics
NPI:1134741713
Name:CREATIVE AND MEANINGFUL PLAY C.A.M.P. THERAPY CENTER
Entity type:Organization
Organization Name:CREATIVE AND MEANINGFUL PLAY C.A.M.P. THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:HALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-404-6370
Mailing Address - Street 1:1706 TILDEN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-3116
Mailing Address - Country:US
Mailing Address - Phone:513-404-6370
Mailing Address - Fax:
Practice Address - Street 1:1106 8TH ST STE A
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-2324
Practice Address - Country:US
Practice Address - Phone:513-404-6370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-17
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty