MEDICARE: THERABILITY PEDIATRIC THERAPY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1033077938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERABILITY PEDIATRIC THERAPY SERVICES

Provider Business Mailing Address
First Line	:	1 TOBIN AVE
Second Line	:
City	:	WEST CALDWELL
State	:	NJ
Zip	:	07006-7914
Country	:	US
Telephone Number	:	973-271-1787
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 TOBIN AVE
Second Line	:
City	:	WEST CALDWELL
State	:	NJ
Zip	:	07006-7914
Country	:	US
Telephone Number	:	973-271-1787
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KEVIN NELSON
Credential	:	OT
Telephone Number	:	973-271-1787

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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