Healthcare Provider Details

I. General information

NPI: 1316687973
Provider Name (Legal Business Name): MINDFUL MOVEMENTS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 03/31/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 TULIP ST
SUMMIT NJ
07901-3413
US

IV. Provider business mailing address

86 TULIP ST
SUMMIT NJ
07901-3413
US

V. Phone/Fax

Practice location:
  • Phone: 908-246-9610
  • Fax:
Mailing address:
  • Phone: 908-246-9610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAYLOR SUZANNE HOFFMAN
Title or Position: OWNER, OCCUPATIONAL THERAPIST
Credential: MS, OTR/L
Phone: 908-246-9610