Provider Demographics
NPI:1659749349
Name:KIDTHERAPY - CHESTER, LLC
Entity Type:Organization
Organization Name:KIDTHERAPY - CHESTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-879-7067
Mailing Address - Street 1:95 W MAIN ST STE 18
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-2487
Mailing Address - Country:US
Mailing Address - Phone:908-879-7067
Mailing Address - Fax:908-879-4117
Practice Address - Street 1:95 W MAIN ST STE 18
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2487
Practice Address - Country:US
Practice Address - Phone:908-879-7067
Practice Address - Fax:908-879-4117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00016300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty