Provider Demographics
NPI:1447893730
Name:BRAIN-BODY OT SENSORY GYM LLC
Entity type:Organization
Organization Name:BRAIN-BODY OT SENSORY GYM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MSOTR/L
Authorized Official - Phone:732-858-5790
Mailing Address - Street 1:479 RTE 79 STE 15
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-4088
Mailing Address - Country:US
Mailing Address - Phone:732-858-5790
Mailing Address - Fax:334-401-2588
Practice Address - Street 1:479 RTE 79 STE 15
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-4088
Practice Address - Country:US
Practice Address - Phone:732-858-5790
Practice Address - Fax:334-401-2588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-19
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty