Healthcare Provider Details

I. General information

NPI: 1457677676
Provider Name (Legal Business Name): VOLT WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 HARRINGTON AVE STE 8
CLOSTER NJ
07624-1912
US

IV. Provider business mailing address

294 HARRINGTON AVE STE 8
CLOSTER NJ
07624-1912
US

V. Phone/Fax

Practice location:
  • Phone: 201-585-0853
  • Fax: 201-585-0853
Mailing address:
  • Phone: 201-585-0853
  • Fax: 201-585-0853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY MITCHELL POTTER
Title or Position: CLINICAL DIRECTOR
Credential: BCBA LBA
Phone: 201-585-0853