Provider Demographics
NPI:1235922758
Name:PLAY FOR LIFE THERAPY LLC
Entity type:Organization
Organization Name:PLAY FOR LIFE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MOTR/L
Authorized Official - Phone:662-832-8017
Mailing Address - Street 1:56 ASPEN CIR
Mailing Address - Street 2:
Mailing Address - City:DIVIDE
Mailing Address - State:CO
Mailing Address - Zip Code:80814-9611
Mailing Address - Country:US
Mailing Address - Phone:662-832-8017
Mailing Address - Fax:
Practice Address - Street 1:400 W MIDLAND AVE STE 230
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-3203
Practice Address - Country:US
Practice Address - Phone:662-832-8017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-27
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty