Basic Information
| Provider Information | |||||||||
| NPI: | 1982065678 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RESTORE OCCUPATIONAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 693 MAIN ST STE 2 | ||||||||
| Address2: | |||||||||
| City: | NEW MILFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 188347200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704652027 | ||||||||
| FaxNumber: | 5704652028 | ||||||||
| Practice Location | |||||||||
| Address1: | 693 MAIN ST STE 2 | ||||||||
| Address2: | |||||||||
| City: | NEW MILFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 188347200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704652027 | ||||||||
| FaxNumber: | 5704652028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2016 | ||||||||
| LastUpdateDate: | 08/12/2016 | ||||||||
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| AuthorizedOfficialLastName: | BRANT | ||||||||
| AuthorizedOfficialFirstName: | PAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5704652027 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | 225XP0019X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation |
No ID Information.