Provider Demographics
NPI:1992818579
Name:OT VISION REHAB LLC
Entity type:Organization
Organization Name:OT VISION REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:GOLDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OTR L
Authorized Official - Phone:856-404-2207
Mailing Address - Street 1:339 NORTH ROUTE 73 SOUTH
Mailing Address - Street 2:SUITE 4 WINSLOW PROFESSIONAL BLDG
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009
Mailing Address - Country:US
Mailing Address - Phone:856-404-2207
Mailing Address - Fax:
Practice Address - Street 1:339 NORTH ROUTE 73 SOUTH
Practice Address - Street 2:SUITE 4 WINSLOW PROFESSIONAL BLDG
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009
Practice Address - Country:US
Practice Address - Phone:856-404-2207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00234900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ104362Medicare PIN