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General NPI Number Information
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NPI Number | 1669859773
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Entity Type | Organization
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Legal Business Name | OT TREEHOUSE, LLC
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Dates
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Enumeration Date | 04/28/2015
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Last Update Date | 04/29/2015
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Provider Practice Location Address
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Address Line | 23 KILMER DR BUILDING 1, SUITE C/D
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City | MORGANVILLE
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State | NJ
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Zip | 07751-1563
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Country | US
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Telephone | 908-670-1086
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Fax |
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Provider Business Mailing Address
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Address Line | 23 KILMER DR BUILDING 1, SUITE C/D
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City | MORGANVILLE
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State | NJ
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Zip | 07751-1563
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BETH GRAZIANO
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Credential | OTR
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Telephone | 908-670-1086
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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 | 46TR00084800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 46TR00084800
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License Number State | NJ
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