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NPI Code Detail

MEDICARE: BEACON PEDIATRIC THERAPY SERVICES LLC

MEDICARE: BEACON PEDIATRIC THERAPY SERVICES LLC
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
1225X00000XOccupational Therapist
2225XF0002XFeeding, Eating & Swallowing Occupational Therapist
3235Z00000XSpeech-Language Pathologist
4225XP0200XPediatric Occupational Therapist

General Provider Information

NPI Number : 1043952146
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEACON PEDIATRIC THERAPY SERVICES LLC
Provider Business Mailing Address
First Line : 504 CENTER ST
Second Line :
City : FORKED RIVER
State : NJ
Zip : 08731-2338
Country : US
Telephone Number : 732-580-0719
Fax Number :
Provider Business Practice Location Address
First Line : 2 HOLLYWOOD BLVD N STE 8
Second Line :
City : FORKED RIVER
State : NJ
Zip : 08731-4842
Country : US
Telephone Number : 609-200-1118
Fax Number : 866-368-4449
Authorized Official
Title or Position : OCCUPATIONAL THERAPIST/OWNER
Name : SARA WILBERT
Credential : OTR
Telephone Number : 732-580-0719
Provider Enumeration Date : 04/09/2022
Last Update Date : 09/28/2023

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