=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184247678
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAMILTON PEDIATRIC THERAPY LIMITED LIABILTIY COMPANY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2020
-----------------------------------------------------
Last Update Date | 05/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 207 HIGHLAND AVE
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08620-2910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-658-3875
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 207 HIGHLAND AVE
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08620-2910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-658-3875
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. ANDRID HOUTRAS
-----------------------------------------------------
Credential | MS,OTR/L
-----------------------------------------------------
Telephone | 609-658-3875
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------