Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 46TR00843500 | NJ |
NPI | 1306328182 |
---|---|
Provider Name | Rebecca Stavis-Weyser |
First Address | Jersey City, NJ 07306-1356 |
Second Address | Jersey City, NJ 07306-1356 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2018 |
Last Update Date | 29/08/2018 |