Provider Demographics
NPI:1871783431
Name:CHILD'S PLAY PEDIATRIC THERAPY, INC.
Entity type:Organization
Organization Name:CHILD'S PLAY PEDIATRIC THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR-L
Authorized Official - Phone:817-508-8737
Mailing Address - Street 1:PO BOX 2023
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76202-2023
Mailing Address - Country:US
Mailing Address - Phone:940-384-6200
Mailing Address - Fax:940-382-7680
Practice Address - Street 1:4113 GATEWAY DR
Practice Address - Street 2:STE 200
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5943
Practice Address - Country:US
Practice Address - Phone:817-508-8737
Practice Address - Fax:817-508-5735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110953174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0032PQOtherBCBS
TX0032PQOtherBCBS