Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 46TR00009400 | NJ |
NPI | 1003009820 |
---|---|
Provider Name | Mrs. Michelle Andre Barbagallo |
First Address | Bridgewater, NJ 08807-2236 |
Second Address | Mountainside, NJ 07092-2590 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2007 |
Last Update Date | 24/08/2007 |