Provider Demographics
NPI:1679695381
Name:PEDIPLAY LLC
Entity type:Organization
Organization Name:PEDIPLAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:P
Authorized Official - Last Name:BLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:317-791-9031
Mailing Address - Street 1:6239 S EAST ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-2090
Mailing Address - Country:US
Mailing Address - Phone:317-791-9031
Mailing Address - Fax:317-791-9001
Practice Address - Street 1:6239 S EAST ST
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-2090
Practice Address - Country:US
Practice Address - Phone:317-791-9031
Practice Address - Fax:317-791-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31001006 A225X00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200731390 AMedicaid
IN201134240AMedicaid
IN200731390AOtherFIRST STEPS PROVIDER