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General NPI Number Information
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NPI Number | 1760805774
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC REHAB LLC
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Dates
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Enumeration Date | 01/27/2014
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Last Update Date | 01/28/2014
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Provider Practice Location Address
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Address Line | 227 HOLLAND RD
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City | HOLMDEL
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State | NJ
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Zip | 07733-1216
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Country | US
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Telephone | 917-656-6757
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Fax |
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Provider Business Mailing Address
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Address Line | 227 HOLLAND RD
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City | HOLMDEL
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State | NJ
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Zip | 07733-1216
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Country | US
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Telephone | 917-656-6757
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | IGOR KOVAL
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Credential | OTR
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Telephone | 917-656-6757
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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 | 46TR 00390900
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License Number State | NJ
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