Provider Demographics
NPI:1770941213
Name:BOBILES, AILEEN ROSE T (OTR/L)
Entity type:Individual
Prefix:MS
First Name:AILEEN ROSE
Middle Name:T
Last Name:BOBILES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:AILEEN
Other - Middle Name:ROSE
Other - Last Name:BOBILES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:168 TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-4149
Mailing Address - Country:US
Mailing Address - Phone:201-795-1561
Mailing Address - Fax:
Practice Address - Street 1:1905 NW CORPORATE BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7315
Practice Address - Country:US
Practice Address - Phone:800-875-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-28
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-03156225X00000X
CA16197225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist