Provider Demographics
NPI:1629559372
Name:TRIVEDI, REEMA (OTR/L)
Entity Type:Individual
Prefix:
First Name:REEMA
Middle Name:
Last Name:TRIVEDI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4344 KISSENA BLVD APT 4M
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3760
Mailing Address - Country:US
Mailing Address - Phone:347-777-4505
Mailing Address - Fax:
Practice Address - Street 1:13 STONEHENGE RD
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-2614
Practice Address - Country:US
Practice Address - Phone:862-621-9390
Practice Address - Fax:973-228-3106
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00831900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist