Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 46TR00028700 | NJ |
NPI | 1154507341 |
---|---|
Provider Name | Ms. Joan Revak |
First Address | Cherry Hill, NJ 08002-2746 |
Second Address | Cherry Hill, NJ 08002-2746 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2008 |
Last Update Date | 11/01/2017 |