Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XF0002X | Feeding, Eating & Swallowing | 46TR00526900 | NJ |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 46TR00526900 | NJ |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 46TR00526900 | NJ |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 46TR00526900 | NJ |
NPI | 1417499203 |
---|---|
Provider Name | Melissa Lee Delatorre |
First Address | Westwood, NJ 07675-3431 |
Second Address | Westwood, NJ 07675-3431 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2016 |
Last Update Date | 09/11/2016 |