Provider Demographics
NPI:1467851477
Name:PATHWAYS OT THERAPEUTIC WELLNESS PLLC
Entity Type:Organization
Organization Name:PATHWAYS OT THERAPEUTIC WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:EBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MS OTR
Authorized Official - Phone:732-761-0708
Mailing Address - Street 1:1642 63RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-2744
Mailing Address - Country:US
Mailing Address - Phone:718-234-5700
Mailing Address - Fax:718-234-5755
Practice Address - Street 1:1642 63RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-2744
Practice Address - Country:US
Practice Address - Phone:718-234-5700
Practice Address - Fax:718-234-5755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006813252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency