Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 46TR00809600 | NJ |
NPI | 1073000220 |
---|---|
Provider Name | Jessica Perchaluk |
First Address | Lambertville, NJ 08530-1506 |
Second Address | Nutley, NJ 07110-2712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2018 |
Last Update Date | 13/04/2018 |