Provider Demographics
NPI:1659668986
Name:ON THE MOVE OCCUPATIONAL THERAPY, PLLC
Entity Type:Organization
Organization Name:ON THE MOVE OCCUPATIONAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, MSOTR/L
Authorized Official - Phone:315-934-4459
Mailing Address - Street 1:219 COUNTY ROUTE 57
Mailing Address - Street 2:UNIT 20, BOX 3
Mailing Address - City:PHOENIX
Mailing Address - State:NY
Mailing Address - Zip Code:13135-3300
Mailing Address - Country:US
Mailing Address - Phone:315-934-4459
Mailing Address - Fax:315-934-4459
Practice Address - Street 1:219 COUNTY ROUTE 57
Practice Address - Street 2:UNIT 20, BOX 3
Practice Address - City:PHOENIX
Practice Address - State:NY
Practice Address - Zip Code:13135-3300
Practice Address - Country:US
Practice Address - Phone:315-934-4459
Practice Address - Fax:315-934-4459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015186225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty