Provider Demographics
NPI:1922811918
Name:PLAYFUL STRIDES
Entity type:Organization
Organization Name:PLAYFUL STRIDES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENTI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:831-216-8591
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:MOUNT HERMON
Mailing Address - State:CA
Mailing Address - Zip Code:95041-0344
Mailing Address - Country:US
Mailing Address - Phone:831-216-8591
Mailing Address - Fax:831-480-5841
Practice Address - Street 1:114 QUAIL HOLLOW RD
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:CA
Practice Address - Zip Code:95018-9452
Practice Address - Country:US
Practice Address - Phone:831-216-8591
Practice Address - Fax:831-480-5841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty