Provider Demographics
NPI:1982065678
Name:RESTORE OCCUPATIONAL THERAPY
Entity Type:Organization
Organization Name:RESTORE OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-465-2027
Mailing Address - Street 1:693 MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18834-7200
Mailing Address - Country:US
Mailing Address - Phone:570-465-2027
Mailing Address - Fax:570-465-2028
Practice Address - Street 1:693 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18834-7200
Practice Address - Country:US
Practice Address - Phone:570-465-2027
Practice Address - Fax:570-465-2028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Single Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty