Healthcare Provider Details

I. General information

NPI: 1083967319
Provider Name (Legal Business Name): THE THERAPEUTIC PUZZLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 INDEPENDENCE BLVD
SICKLERVILLE NJ
08081-1094
US

IV. Provider business mailing address

401 INDEPENDENCE BLVD
SICKLERVILLE NJ
08081-1094
US

V. Phone/Fax

Practice location:
  • Phone: 856-210-2777
  • Fax: 609-228-0678
Mailing address:
  • Phone: 856-210-2777
  • Fax: 609-228-0678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number46TR00350400
License Number StateNJ

VIII. Authorized Official

Name: KELLY MARIE CAMM
Title or Position: DIRECTOR OF OPERATIONS
Credential: OTR/L
Phone: 856-210-2777