Healthcare Provider Details

I. General information

NPI: 1548749872
Provider Name (Legal Business Name): CAROLINE RAFAILOV OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 RIVER AVE STE 201
LAKEWOOD NJ
08701-5675
US

IV. Provider business mailing address

1175 CECIL CT
LAKEWOOD NJ
08701-5865
US

V. Phone/Fax

Practice location:
  • Phone: 732-833-3723
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00814900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: