Provider Demographics
NPI:1851619225
Name:BREAST REHABILITATION & HEALING CENTER
Entity Type:Organization
Organization Name:BREAST REHABILITATION & HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/CHT/CLT
Authorized Official - Phone:201-497-6175
Mailing Address - Street 1:99 KINDERKAMACK ROAD SUITE 204
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3012
Mailing Address - Country:US
Mailing Address - Phone:201-497-6175
Mailing Address - Fax:201-497-6212
Practice Address - Street 1:99 KINDERKAMACK RD STE 204
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3020
Practice Address - Country:US
Practice Address - Phone:201-497-6175
Practice Address - Fax:201-497-6212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR000935000225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Single Specialty