Basic Information
| Provider Information | |||||||||
| NPI: | 1912251992 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FOX REHAB OT CT, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 CARNEGIE PLZ | ||||||||
| Address2: | |||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080031000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8774073422 | ||||||||
| FaxNumber: | 8774074329 | ||||||||
| Practice Location | |||||||||
| Address1: | 44 OLD RIDGEFIELD ROAD | ||||||||
| Address2: | SUITE 213 | ||||||||
| City: | WILTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068973014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8774073422 | ||||||||
| FaxNumber: | 8774074329 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2012 | ||||||||
| LastUpdateDate: | 06/11/2013 | ||||||||
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| AuthorizedOfficialLastName: | FOX | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8774073422 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT, DPT, GCS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.