Basic Information
| Provider Information | |||||||||
| NPI: | 1255838157 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HART | ||||||||
| FirstName: | FREDERICK | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | III | ||||||||
| Credential: | MOT, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 923 LINWOOD AVE APT A | ||||||||
| Address2: | |||||||||
| City: | COLLINGSWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081083214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158735570 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1934 BURLINGTON-MT. HOLLY ROAD SUITE A | ||||||||
| Address2: | |||||||||
| City: | WESTAMPTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092614330 | ||||||||
| FaxNumber: | 6092614490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2018 | ||||||||
| LastUpdateDate: | 04/09/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 46TR00815500 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | OC012729 | 01 | PA | OCCUPATIONAL THERAPIST LICENSE | OTHER | 46TR00815500 | 01 | NJ | OCCUPATIONAL THERAPIST LICENSE | OTHER |