Healthcare Provider Details

I. General information

NPI: 1356796148
Provider Name (Legal Business Name): BERNADETTE REID OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SEAVIEW AVE APARTMENT 4-4B
MONMOUTH BEACH NJ
07750-1256
US

IV. Provider business mailing address

100 SEAVIEW AVE APARTMENT 4-4B
MONMOUTH BEACH NJ
07750-1256
US

V. Phone/Fax

Practice location:
  • Phone: 908-692-5307
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number46TR00618600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: