MEDICARE: JUMP THERAPY 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
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1972090546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUMP THERAPY LLC

Provider Business Mailing Address
First Line	:	16-00 ROUTE 208
Second Line	:
City	:	FAIR LAWN
State	:	NJ
Zip	:	07410-2503
Country	:	US
Telephone Number	:	201-794-7700
Fax Number	:	201-794-7701

Provider Business Practice Location Address
First Line	:	16-00 ROUTE 208
Second Line	:
City	:	FAIR LAWN
State	:	NJ
Zip	:	07410-2503
Country	:	US
Telephone Number	:	201-794-7700
Fax Number	:	201-794-7701

Authorized Official
Title or Position	:	FOUNDER AND DIRECTOR
Name	:	MIRIAM SKYDELL
Credential	:	MS,OTR/L
Telephone Number	:	201-794-7700

Provider Enumeration Date	:	04/18/2018
Last Update Date	:	04/18/2018

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Directions to “JUMP THERAPY LLC ” Practice Location

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