Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 46TR00167400 | NJ |
NPI | 1326240912 |
---|---|
Provider Name | Miss Michelle Hibbert |
First Address | Orange, NJ 07050-3411 |
Second Address | Orange, NJ 07050-3411 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 08/07/2007 |