Provider Demographics
NPI:1598069981
Name:OCCUPATIONAL THERAPY ASSOCIATES OF PRINCETON
Entity Type:Organization
Organization Name:OCCUPATIONAL THERAPY ASSOCIATES OF PRINCETON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:609-921-1555
Mailing Address - Street 1:219 WALL ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1512
Mailing Address - Country:US
Mailing Address - Phone:609-921-1555
Mailing Address - Fax:609-921-1065
Practice Address - Street 1:219 WALL ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1512
Practice Address - Country:US
Practice Address - Phone:609-921-1555
Practice Address - Fax:609-921-1065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00224700225XP0200X
NJ46TR00687200225XP0200X
NJ46TR00042900225XP0200X
NJ46TR00015000225XP0200X
NJ46TR00170000225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty