Healthcare Provider Details

I. General information

NPI: 1053012682
Provider Name (Legal Business Name): PREMIER OCCUPATIONAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 BLAINE AVE UNIT 20
SEASIDE HEIGHTS NJ
08751-2101
US

IV. Provider business mailing address

21 BLAINE AVE UNIT 20
SEASIDE HEIGHTS NJ
08751-2101
US

V. Phone/Fax

Practice location:
  • Phone: 732-492-6767
  • Fax:
Mailing address:
  • Phone: 732-492-6767
  • 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: MRS. DORIT MICHAL SNOW
Title or Position: OCCUPATIONAL THERAPIST LICENSED
Credential:
Phone: 732-492-6767