Provider Demographics
NPI:1821215278
Name:OCCUPATIONAL THERAPY SERVICES OF PEDIATRIC REHAB NETWORK
Entity Type:Organization
Organization Name:OCCUPATIONAL THERAPY SERVICES OF PEDIATRIC REHAB NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:GRINOVICS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:856-983-6160
Mailing Address - Street 1:475 OLD MARLTON PIKE W
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2098
Mailing Address - Country:US
Mailing Address - Phone:856-983-6160
Mailing Address - Fax:856-983-6162
Practice Address - Street 1:475 OLD MARLTON PIKE W
Practice Address - Street 2:SUITE 1
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2098
Practice Address - Country:US
Practice Address - Phone:856-983-6160
Practice Address - Fax:856-983-6162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00154400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty