Healthcare Provider Details

I. General information

NPI: 1649588930
Provider Name (Legal Business Name): TOVA REISMAN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TOVA REISMAN OT

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 RIVER AVE
LAKEWOOD NJ
08701-5228
US

IV. Provider business mailing address

172 COLONIAL DR
LAKEWOOD NJ
08701-5851
US

V. Phone/Fax

Practice location:
  • Phone: 732-364-3772
  • Fax:
Mailing address:
  • Phone: 732-901-6733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR000423400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: