Provider Demographics
NPI:1649588930
Name:REISMAN, TOVA (OT)
Entity Type:Individual
Prefix:
First Name:TOVA
Middle Name:
Last Name:REISMAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:TOVA
Other - Middle Name:
Other - Last Name:REISMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:172 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5851
Mailing Address - Country:US
Mailing Address - Phone:732-901-6733
Mailing Address - Fax:
Practice Address - Street 1:685 RIVER AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5228
Practice Address - Country:US
Practice Address - Phone:732-364-3772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR000423400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist