MEDICARE: KRISTEN CLARK INC. DBA HARMONY PEDIATRIC THERAPY

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	225XP0200X	Pediatric Occupational Therapist		NJ

General Provider Information

NPI Number	:	1912400201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRISTEN CLARK INC. DBA HARMONY PEDIATRIC THERAPY

Provider Business Mailing Address
First Line	:	5 TOWNSQUARE STE A
Second Line	:
City	:	CHATHAM
State	:	NJ
Zip	:	07928-2568
Country	:	US
Telephone Number	:	973-507-9730
Fax Number	:	973-507-9710

Provider Business Practice Location Address
First Line	:	5 TOWNSQUARE STE A
Second Line	:
City	:	CHATHAM
State	:	NJ
Zip	:	07928-2568
Country	:	US
Telephone Number	:	973-507-9730
Fax Number	:	973-507-9710

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	NANCY CALTAGIRONE
Credential	:
Telephone Number	:	973-507-9730

Provider Enumeration Date	:	03/13/2018
Last Update Date	:	03/13/2018

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