Healthcare Provider Details

I. General information

NPI: 1629489604
Provider Name (Legal Business Name): SENSORY SMART OT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W MAIN ST SUITE 2
FREEHOLD NJ
07728-2523
US

IV. Provider business mailing address

900 W MAIN ST SUITE 2
FREEHOLD NJ
07728-2523
US

V. Phone/Fax

Practice location:
  • Phone: 732-252-6666
  • Fax: 732-431-3603
Mailing address:
  • Phone: 732-252-6666
  • Fax: 732-431-3603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number46TR00062200
License Number StateNJ

VIII. Authorized Official

Name: MRS. LISA DICHTER
Title or Position: OCCUPATIONAL THERAPY
Credential: MS OTR/L
Phone: 732-252-6666