Provider Demographics
NPI:1942801824
Name:PIVOTAL PERFORMANCE OCCUPATIONAL THERAPY LLC
Entity Type:Organization
Organization Name:PIVOTAL PERFORMANCE OCCUPATIONAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO AND PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MURIEL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:845-474-2361
Mailing Address - Street 1:46 RADCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3641
Mailing Address - Country:US
Mailing Address - Phone:845-474-2361
Mailing Address - Fax:845-639-4007
Practice Address - Street 1:46 RADCLIFF DR
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3641
Practice Address - Country:US
Practice Address - Phone:845-474-2361
Practice Address - Fax:845-639-4007
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIVOTAL PERFORMANCE OCCUPATIONAL THERAPY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty