Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | TR002213 | NJ |
NPI | 1467067793 |
---|---|
Provider Name | Karen Wauters |
First Address | Summit, NJ 07901-3027 |
Second Address | Summit, NJ 07901-3027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2020 |
Last Update Date | 14/09/2020 |