Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 46TR00187900 | NJ |
NPI | 1700299179 |
---|---|
Provider Name | Mrs. Deborah Ann Ambrose |
First Address | Mendham, NJ 07945-2021 |
Second Address | Mendham, NJ 07945-2021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2014 |
Last Update Date | 03/06/2014 |