Basic Information
| Provider Information | |||||||||
| NPI: | 1710170659 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAN HOOYDONK | ||||||||
| FirstName: | ELKE | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 94 STEVENS RD | ||||||||
| Address2: | |||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087551237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7329141100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 94 STEVENS RD | ||||||||
| Address2: | |||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087551237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7329141100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2007 | ||||||||
| LastUpdateDate: | 08/23/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 46TR00192000 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 46TR00192000 | 01 | NJ | STATE OF NJ, LICENSE | OTHER | 1032986 | 01 | NBCOT | OTHER |