Provider Demographics
NPI:1356925176
Name:LIFE FUN THERAPY
Entity type:Organization
Organization Name:LIFE FUN THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:609-970-3354
Mailing Address - Street 1:1409 ENDINGO AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-8762
Mailing Address - Country:US
Mailing Address - Phone:609-970-3354
Mailing Address - Fax:
Practice Address - Street 1:1409 ENDINGO AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-8762
Practice Address - Country:US
Practice Address - Phone:609-970-3354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251E00000XAgenciesHome Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service