Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 46TR00392700 | NJ |
N | 225XP0200X | Occupational Therapist - Pediatrics | 46TR00392700 | NJ |
NPI | 1104044239 |
---|---|
Provider Name | Miss Nicole Nowakowski |
First Address | East Brunswick, NJ 08816-2513 |
Second Address | Somerset, NJ 08873-2762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 10/10/2011 |