Provider Demographics
NPI:1609410216
Name:THERAPY BY DESIGN
Entity Type:Organization
Organization Name:THERAPY BY DESIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:917-312-2252
Mailing Address - Street 1:8305 BERGENLINE AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5059
Mailing Address - Country:US
Mailing Address - Phone:917-312-2252
Mailing Address - Fax:
Practice Address - Street 1:8305 BERGENLINE AVE APT 8
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5059
Practice Address - Country:US
Practice Address - Phone:917-312-2252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty