Organization
KRATOS REHABILITATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LIDA EUDALY FERNANDEZ OT (BUSINESS OWNER/OT)
(908) 906-0978
Entity
Organization
Contact information
Practice address
171 ELMORA AVE, ELIZABETH, NJ 07202-1169
(908) 906-0978
Mailing address
329 VINE ST, ELIZABETH, NJ 07202-1817
(908) 906-0978
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
46TR00354400
NJ STATE LICENSE
NJ
Enumeration date
01/02/2020
Last updated
01/02/2020
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