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General NPI Number Information
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NPI Number | 1225977812
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Entity Type | Organization
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Legal Business Name | RESILIENT ROOTS OT LLC
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Dates
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Enumeration Date | 03/27/2026
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Last Update Date | 03/27/2026
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Provider Practice Location Address
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Address Line | 12 REMINGTON DR
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City | EDISON
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State | NJ
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Zip | 08820-3635
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Country | US
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Telephone | 732-236-3485
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Fax |
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Provider Business Mailing Address
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Address Line | 550 COOKMAN AVE APT 225
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City | ASBURY PARK
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State | NJ
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Zip | 07712-7182
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Country | US
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Telephone | 732-236-3485
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Fax |
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Authorized Official
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Title or Position | MEMBER/PART OWNER
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Name | MCKENNA MARY DICK
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Credential | OTR/L
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Telephone | 732-236-3485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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