Basic Information
| Provider Information | |||||||||
| NPI: | 1700530433 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMALLETZ | ||||||||
| FirstName: | CINDY | ||||||||
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| Credential: | OTR/L, BCB | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 MIDLAND AVE | ||||||||
| Address2: | |||||||||
| City: | GLEN RIDGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070282012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732297748 | ||||||||
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| Practice Location | |||||||||
| Address1: | 515 MADISON AVE FL 6 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100225403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127526770 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2022 | ||||||||
| LastUpdateDate: | 02/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 46TR01009600 | NJ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 025751 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.