Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 46TR00339900 | NJ |
NPI | 1063560613 |
---|---|
Provider Name | Jessica Coletta |
First Address | Berkeley Hts, NJ 07922-1871 |
Second Address | West Caldwell, NJ 07006-7127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 08/07/2007 |