Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 46TR00149100 | NJ |
NPI | 1093797359 |
---|---|
Provider Name | Mrs. Sally P Gillenson |
First Address | Parsippany, NJ 07054-4913 |
Second Address | Hackensack, NJ 07601-2570 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 22/07/2008 |