Provider Demographics
NPI:1952599201
Name:THE CHILDRENS SOURCE FOR THERAPY LLC
Entity Type:Organization
Organization Name:THE CHILDRENS SOURCE FOR THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYKISH
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:973-226-5052
Mailing Address - Street 1:556 EAGLE ROCK AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROSELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07068
Mailing Address - Country:US
Mailing Address - Phone:973-226-5052
Mailing Address - Fax:973-226-4502
Practice Address - Street 1:556 EAGLE ROCK AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068
Practice Address - Country:US
Practice Address - Phone:973-226-5052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty