Organization
MINDFUL MOMENTS PEDIATRIC THERAPY & WELLNESS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY NICOLE GREVERA OTR/L (OCCUPATIONAL THERAPIST)
(570) 690-4908
Entity
Organization
Contact information
Practice address
2449 STATE ROUTE 118 STE 2, HUNLOCK CREEK, PA 18621-5022
(570) 690-4908
Mailing address
2449 STATE ROUTE 118 STE 2, HUNLOCK CREEK, PA 18621-5022
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1036058570001
—
PA
Enumeration date
12/29/2020
Last updated
12/29/2020
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