Theraplay, Inc.
Organization Active NPI Pediatric Occupational Therapist · Grand Rapids, MI
NPI 1902176258 · NPPES record last updated Feb 12, 2019
Key facts
- NPI
- 1902176258
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatric Occupational Therapist 225XP0200X
- License
- 5201006016 (MI)
- Legal business name
- THERAPLAY, INC.
- Practice address
- 2251 E Paris Ave SE
Grand Rapids, MI 49546-2431 - Phone
- (616) 447-7799
- NPI assigned
- Jan 4, 2012
- Organization subpart
- No
Authorized official
- Name
- Teresa L Cooper, MSOT
- Title
- Owner
- Phone
- (616) 447-7799
Practitioners 12
-
Sandin Kekic, OTD, OTR/L
-
Megan Mitchell, MSOT, OTR/L
-
Courtney Lyn Dumouchelle, MS, CCC-SLP
-
Shannon Marie Mulder, MS-CCC-SLP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120821001080 | MI | Part B Supplier - Clinic/Group Practice | 7113174442 |
Receives reassigned benefits from 8 practitioners Practice locations: Grand Haven, MI; Rockford, MI; Grand Rapids, MI |
National Provider Directory
Locations
2460 Burton St SE
Ste 100
Grand Rapids, MI 49546
Phone (616) 333-2721
570 E Division St
Rockford, MI 49341
Phone (616) 447-7799
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist |
225XP0200X | 5201006016 | MI | Yes |
Addresses
Primary practice location
2251 E Paris Ave SE
Grand Rapids, MI 49546-2431
Mailing address
2251 East Paris Ave SE
Grand Rapids, MI 49546-2431
Phone (616) 447-7799
NPI Registry JSON
{
"created_epoch": "1325635200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1549929600000",
"number": "1902176258",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2251 EAST PARIS AVE SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495462431",
"telephone_number": "616-447-7799"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2251 E PARIS AVE SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495462431",
"telephone_number": "616-447-7799"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "THERAPLAY, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2012-01-04",
"last_updated": "2019-02-12",
"status": "A",
"authorized_official_last_name": "COOPER",
"authorized_official_first_name": "TERESA",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "616-447-7799",
"authorized_official_credential": "MSOT"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Occupational Therapist, Pediatrics",
"state": "MI",
"license": "5201006016",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
- Melissa Carol Thelen
- Tamara L Thelen
- Trisha Thelen
- Zachary Thelen
- Fiona Madalena Theodoroff
- Therapy Center for Behavioral Health and Rehabilitation
- Therapy Management Inc
- Therapy Now LLC
- Therapy Specialists, Inc.
- Ashley Noelle Therasse
All providers in Grand Rapids, MI · Pediatric Occupational Therapist in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 12, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.