Healthcare Provider Details

I. General information

NPI: 1619100435
Provider Name (Legal Business Name): PROFESSIONAL THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 08/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CAROLINE CT
PILESGROVE NJ
08098-2741
US

IV. Provider business mailing address

111 S BROADWAY SUITE A
PENNSVILLE NJ
08070-2038
US

V. Phone/Fax

Practice location:
  • Phone: 856-769-1049
  • Fax: 856-769-1049
Mailing address:
  • Phone: 856-678-4701
  • Fax: 856-678-4702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number46TR001115
License Number StateNJ

VIII. Authorized Official

Name: MS. GERALDINE HEALY MARINI
Title or Position: DIRECTOR
Credential: OT
Phone: 856-678-4701