Healthcare Provider Details

I. General information

NPI: 1548174659
Provider Name (Legal Business Name): OUTSIDE THE BOX PEDIATRIC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2794 CHEYENNE DR
GRAND JUNCTION CO
81503-2870
US

IV. Provider business mailing address

2794 CHEYENNE DR
GRAND JUNCTION CO
81503-2870
US

V. Phone/Fax

Practice location:
  • Phone: 973-476-6660
  • Fax:
Mailing address:
  • Phone: 973-476-6660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: NINA ROSE INCORVAIA
Title or Position: OWNER
Credential: OTR/L
Phone: 973-476-6660