Provider Demographics
NPI:1275250573
Name:CD COMMUNITY-BASED OT SERVICES, LLC
Entity Type:Organization
Organization Name:CD COMMUNITY-BASED OT SERVICES, LLC
Other - Org Name:BLUE DOT: SOCIAL & COMMUNITY WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTEN
Authorized Official - Middle Name:MARISSA
Authorized Official - Last Name:D'AMICO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:732-865-6974
Mailing Address - Street 1:644A COOKMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ASBURY PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-7104
Mailing Address - Country:US
Mailing Address - Phone:732-865-6974
Mailing Address - Fax:
Practice Address - Street 1:500 MAIN ST UNIT 102
Practice Address - Street 2:
Practice Address - City:BELMAR
Practice Address - State:NJ
Practice Address - Zip Code:07719-2175
Practice Address - Country:US
Practice Address - Phone:732-865-6974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-26
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty