Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 46TR00337600 | NJ |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 46TR00337600 | NJ |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 46TR00337600 | NJ |
NPI | 1285000323 |
---|---|
Provider Name | Raina Michelle Koterba |
First Address | Clifton, NJ 07014-1514 |
Second Address | Little Falls, NJ 07424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2015 |
Last Update Date | 19/06/2018 |