Healthcare Provider Details

I. General information

NPI: 1548924756
Provider Name (Legal Business Name): RAINBOW BODY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 10/25/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 FOREPEAK AVE
BEACHWOOD NJ
08722-2923
US

IV. Provider business mailing address

PO BOX 86 601 PENNSYLVANIA AVE
BEACHWOOD NJ
08722
US

V. Phone/Fax

Practice location:
  • Phone: 732-330-2152
  • Fax:
Mailing address:
  • Phone: 732-330-2152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ELISABETH BAHR
Title or Position: OWNER
Credential: OTD, MS
Phone: 732-330-2152