Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | TR001197 | NJ |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | TR001197 | NJ |
N | 225XP0200X | Occupational Therapist - Pediatrics | TR001197 | NJ |
NPI | 1033573654 |
---|---|
Provider Name | Kim Pearson-Pesciotta |
First Address | Toms River, NJ 08753-2077 |
Second Address | Bayville, NJ 08721-1600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2016 |
Last Update Date | 09/04/2016 |