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General NPI Number Information
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NPI Number | 1447893730
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Entity Type | Organization
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Legal Business Name | BRAIN-BODY OT SENSORY GYM LLC
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Dates
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Enumeration Date | 10/19/2019
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Last Update Date | 10/19/2019
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Provider Practice Location Address
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Address Line | 479 RTE 79 STE 15
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City | MORGANVILLE
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State | NJ
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Zip | 07751-4088
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Country | US
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Telephone | 732-858-5790
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Fax | 334-401-2588
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Provider Business Mailing Address
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Address Line | 479 RTE 79 STE 15
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City | MORGANVILLE
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State | NJ
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Zip | 07751-4088
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Country | US
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Telephone | 732-858-5790
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Fax | 334-401-2588
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Authorized Official
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Title or Position | PARTNER
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Name | MONIQUE DAVIDOFF
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Credential | MSOTR/L
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Telephone | 732-858-5790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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