Healthcare Provider Details

I. General information

NPI: 1205177995
Provider Name (Legal Business Name): PEDIATRIC OT, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 W COUNTY LINE RD
LAKEWOOD NJ
08701-1216
US

IV. Provider business mailing address

35 KEDMA DR
LAKEWOOD NJ
08701-3576
US

V. Phone/Fax

Practice location:
  • Phone: 732-363-1992
  • Fax:
Mailing address:
  • Phone: 732-363-1992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AVIVA ABERBACH
Title or Position: PRESIDENT
Credential: OTRL
Phone: 732-363-1992