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NPI Code Detail

MEDICARE: CAROLINE RAFAILOV OTR/L

MEDICARE: CAROLINE RAFAILOV OTR/L
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 Therapist46TR00814900NJ

General Provider Information

NPI Number : 1548749872
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLINE RAFAILOV OTR/L
Provider Business Mailing Address
First Line : 1175 CECIL CT
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-5865
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 945 RIVER AVE STE 201
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-5675
Country : US
Telephone Number : 732-833-3723
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2018
Last Update Date : 08/08/2018

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Directions to “ CAROLINE RAFAILOV OTR/L” Practice Location

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