Provider Demographics
NPI:1144862533
Name:EAT PLAY LEARN PEDIATRIC THERAPY
Entity type:Organization
Organization Name:EAT PLAY LEARN PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCALLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-288-6647
Mailing Address - Street 1:1057 LAKE ASBURY DR
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-9555
Mailing Address - Country:US
Mailing Address - Phone:386-288-6647
Mailing Address - Fax:904-592-5333
Practice Address - Street 1:108 KINGSLEY AVE STE 2
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5686
Practice Address - Country:US
Practice Address - Phone:904-531-4642
Practice Address - Fax:904-592-5333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-17
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty