Provider Demographics
NPI:1053754911
Name:PLAY TO GROW DEVELOPMENTAL THERAPY SERVICES
Entity type:Organization
Organization Name:PLAY TO GROW DEVELOPMENTAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:503-563-5439
Mailing Address - Street 1:18959 SW 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9477
Mailing Address - Country:US
Mailing Address - Phone:500-356-3543
Mailing Address - Fax:503-563-5281
Practice Address - Street 1:18959 SW 84TH AVE
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9477
Practice Address - Country:US
Practice Address - Phone:500-356-3543
Practice Address - Fax:503-563-5281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR606012225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty