Provider Demographics
NPI:1902063993
Name:EMPOWERED LEARNING CENTER OF MONMOUTH
Entity Type:Organization
Organization Name:EMPOWERED LEARNING CENTER OF MONMOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:F
Authorized Official - Last Name:COUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:732-380-7287
Mailing Address - Street 1:615 HOPE RD
Mailing Address - Street 2:BLDG. 5B 1ST FLOOR
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-1277
Mailing Address - Country:US
Mailing Address - Phone:732-380-7287
Mailing Address - Fax:732-389-7289
Practice Address - Street 1:615 HOPE RD
Practice Address - Street 2:BLDG. 5B 1ST FLOOR
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-1277
Practice Address - Country:US
Practice Address - Phone:732-380-7287
Practice Address - Fax:732-389-7289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00469400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty