NPIMap

Organization Active NPI

Restore Mobile Therapy LLC

  • Occupational Therapist
  • Brookfield, CT
National Provider Identifier
1205451663
Registry record updated Jun 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
RESTORE MOBILE THERAPY LLC
Practice address
6 Logging Trail LN
Brookfield, CT 06804-1345
Phone
(203) 739-5752
NPI assigned
Jun 11, 2020
Last updated
Jun 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2020

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

Authorized official

Name
Stacey McVor, OTR
Title
Owner
Phone
(203) 739-5752

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X Primary

Addresses

Primary practice location

6 Logging Trail LN
Brookfield, CT 06804-1345

Mailing address

6 Logging Trail LN
Brookfield, CT 06804-1345
Phone (203) 739-5752

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200813000467 CT Part B Supplier - Clinic/Group Practice 3072939669 Receives reassigned benefits from 12 practitioners
Practice locations: Brookfield, CT

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": "1591833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591833600000",
    "number": "1205451663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 LOGGING TRAIL LN",
            "city": "BROOKFIELD",
            "state": "CT",
            "postal_code": "068041345",
            "telephone_number": "203-739-5752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 LOGGING TRAIL LN",
            "city": "BROOKFIELD",
            "state": "CT",
            "postal_code": "068041345",
            "telephone_number": "203-739-5752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORE MOBILE THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-11",
        "last_updated": "2020-06-11",
        "certification_date": "2020-06-11",
        "status": "A",
        "authorized_official_last_name": "MCVOR",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-739-5752",
        "authorized_official_credential": "OTR"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.