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General NPI Number Information
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NPI Number | 1659749349
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Entity Type | Organization
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Legal Business Name | KIDTHERAPY - CHESTER, LLC
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Dates
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Enumeration Date | 09/11/2015
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Last Update Date | 09/11/2015
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Provider Practice Location Address
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Address Line | 95 W MAIN ST STE 18
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City | CHESTER
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State | NJ
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Zip | 07930-2487
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Country | US
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Telephone | 908-879-7067
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Fax | 908-879-4117
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Provider Business Mailing Address
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Address Line | 95 W MAIN ST STE 18
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City | CHESTER
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State | NJ
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Zip | 07930-2487
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Country | US
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Telephone | 908-879-7067
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Fax | 908-879-4117
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Authorized Official
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Title or Position | CO-OWNER
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Name | KELLY BERMAN
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Credential |
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Telephone | 908-879-7067
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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 | 46TR00016300
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License Number State | NJ
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