Basic Information
Provider Information
NPI: 1619916798
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES
FirstName: JOAN
MiddleName: MAJELLA
NamePrefix: MRS.
NameSuffix:  
Credential: OTR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 29 WILSON DR
Address2:  
City: SICKLERVILLE
State: NJ
PostalCode: 080814475
CountryCode: US
TelephoneNumber: 8562620064
FaxNumber:  
Practice Location
Address1: 570 EGG HARBOR RD
Address2: SUITE B-6
City: SEWELL
State: NJ
PostalCode: 080802359
CountryCode: US
TelephoneNumber: 8562188050
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/05/2006
LastUpdateDate: 08/20/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X46TR00382300NJY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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