Provider Demographics
NPI:1669986592
Name:PLAYTIME PEDIATRIC THERAPY SERVICES, PLLC
Entity type:Organization
Organization Name:PLAYTIME PEDIATRIC THERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ROGERS
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:865-773-0505
Mailing Address - Street 1:11729 CHAPMAN HWY STE C
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-5181
Mailing Address - Country:US
Mailing Address - Phone:865-773-0505
Mailing Address - Fax:865-773-0439
Practice Address - Street 1:11729 CHAPMAN HWY STE C
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-5181
Practice Address - Country:US
Practice Address - Phone:865-773-0505
Practice Address - Fax:865-773-0439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-30
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty