Provider Demographics
NPI:1598418675
Name:HAWTHORNE PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:HAWTHORNE PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STANTON
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SHERIDAN
Authorized Official - Suffix:II
Authorized Official - Credentials:MS, OTR
Authorized Official - Phone:201-500-8014
Mailing Address - Street 1:173 PASADENA PL
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-2838
Mailing Address - Country:US
Mailing Address - Phone:201-500-8014
Mailing Address - Fax:
Practice Address - Street 1:173 PASADENA PL
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-2838
Practice Address - Country:US
Practice Address - Phone:201-500-8014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-30
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty