Provider Demographics
NPI:1962139196
Name:THERAPY FUNDAMENTALS
Entity type:Organization
Organization Name:THERAPY FUNDAMENTALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:570-664-6005
Mailing Address - Street 1:511 INDEPENDENCE RD
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8202
Mailing Address - Country:US
Mailing Address - Phone:570-664-6005
Mailing Address - Fax:570-664-6885
Practice Address - Street 1:511 INDEPENDENCE RD
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8202
Practice Address - Country:US
Practice Address - Phone:570-664-6005
Practice Address - Fax:570-664-6885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-08
Last Update Date:2024-09-30
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
PA104147353-0001Medicaid
PA104147353-0002Medicaid