NPIMap

Organization Active NPI

Mary's Place Pediatric Rehab, Inc.

  • Pediatric Occupational Therapist
  • Marlton, NJ
National Provider Identifier
1073660387
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
Legal business name
MARY'S PLACE PEDIATRIC REHAB, INC.
Practice address
9004 Lincoln Dr W Ste F
Marlton, NJ 08053-3206
Phone
(856) 988-1160
Fax
(856) 988-1183
NPI assigned
Jan 5, 2007
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tara Montague
Title
President
Phone
(856) 988-1160

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X Primary
Speech-Language Pathologist 235Z00000X

Addresses

Primary practice location

9004 Lincoln Dr W Ste F
Marlton, NJ 08053-3206

Mailing address

9004 Lincoln Dr W Ste F
Marlton, NJ 08053-3206
Phone (856) 988-1160

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1073660387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9004 LINCOLN DR W STE F",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080533206",
            "telephone_number": "856-988-1160",
            "fax_number": "856-988-1183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9004 LINCOLN DR W STE F",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080533206",
            "telephone_number": "856-988-1160",
            "fax_number": "856-988-1183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY'S PLACE PEDIATRIC REHAB, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "MONTAGUE",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "856-988-1160"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marlton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.