Basic Information
| Provider Information | |||||||||
| NPI: | 1972249332 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ON TRACK OCCUPATIONAL THERAPY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 672 COBH RD | ||||||||
| Address2: | |||||||||
| City: | RIVER VALE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076756526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164918697 | ||||||||
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| Practice Location | |||||||||
| Address1: | 672 COBH RD | ||||||||
| Address2: | |||||||||
| City: | RIVER VALE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076756526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164918697 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2022 | ||||||||
| LastUpdateDate: | 05/09/2022 | ||||||||
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| AuthorizedOfficialLastName: | IANNELLO | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | NICOLE | ||||||||
| AuthorizedOfficialTitleorPosition: | OCCUPATIONAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 5164918697 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MS, OTR/L | ||||||||
| NPICertificationDate: | 04/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.