Thera - Play, PLLC

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

OT11104 Issued in FL

Legal business name

THERA - PLAY, PLLC

Practice address

109 Capri Dr
Ormond Beach, FL 32176-2233

Phone

(386) 405-6586

NPI assigned

Nov 28, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Timothy Sean Shirley, OTA/LNPI 1235563156

Title

Owner/Ceo/Therapist

Phone

(386) 405-6586

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Timothy Sean Shirley, COTA/L

  • Occupational Therapy Assistant
  • Ormond Beach, FL
  • NPI 1235563156
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1480291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480291200000",
    "number": "1114460086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 CAPRI DR",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321762233",
            "telephone_number": "386-405-6586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 CAPRI DR",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321762233",
            "telephone_number": "386-405-6586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERA - PLAY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-28",
        "last_updated": "2016-11-28",
        "status": "A",
        "authorized_official_last_name": "SHIRLEY",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "SEAN",
        "authorized_official_title_or_position": "OWNER/CEO/THERAPIST",
        "authorized_official_telephone_number": "386-405-6586",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OTA/L"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "FL",
            "license": "OT11104",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "10889",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Occupational Therapist in Ormond Beach, FL
• Providers in Ormond Beach, FL by specialty
• Pediatric Occupational Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.