Provider Demographics
NPI:1083914204
Name:KLG PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:KLG PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUZZETTI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:609-254-2416
Mailing Address - Street 1:22 PELHAM DR
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08051-1737
Mailing Address - Country:US
Mailing Address - Phone:609-254-2416
Mailing Address - Fax:877-275-5941
Practice Address - Street 1:851 ROUTE 73 N STE C
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1275
Practice Address - Country:US
Practice Address - Phone:856-872-2067
Practice Address - Fax:877-275-5941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00171400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty