Provider Demographics
NPI:1184247678
Name:HAMILTON PEDIATRIC THERAPY LIMITED LIABILTIY COMPANY
Entity type:Organization
Organization Name:HAMILTON PEDIATRIC THERAPY LIMITED LIABILTIY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDRID
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUTRAS
Authorized Official - Suffix:
Authorized Official - Credentials:MS,OTR/L
Authorized Official - Phone:609-658-3875
Mailing Address - Street 1:207 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08620-2910
Mailing Address - Country:US
Mailing Address - Phone:609-658-3875
Mailing Address - Fax:
Practice Address - Street 1:207 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08620-2910
Practice Address - Country:US
Practice Address - Phone:609-658-3875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1760003875OtherNPI