Provider Demographics
NPI:1497519284
Name:BOLSTERS AND BALLS OCCUPATIONAL THERAPY
Entity Type:Organization
Organization Name:BOLSTERS AND BALLS OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVEL
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:917-579-5399
Mailing Address - Street 1:1346 FAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2118
Mailing Address - Country:US
Mailing Address - Phone:917-579-5399
Mailing Address - Fax:
Practice Address - Street 1:1346 FAYETTE ST
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-2118
Practice Address - Country:US
Practice Address - Phone:917-579-5399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty