MEDICARE: MRS. CARMELLE DOROTHY PHILLIPS OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	46TR00366600	NJ

General Provider Information

NPI Number	:	1235325044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARMELLE DOROTHY PHILLIPS OTR

Provider Business Mailing Address
First Line	:	328 LIBERTY AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07307-4428
Country	:	US
Telephone Number	:	917-294-6002
Fax Number	:

Provider Business Practice Location Address
First Line	:	328 LIBERTY AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07307-4428
Country	:	US
Telephone Number	:	917-294-6002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2007
Last Update Date	:	07/12/2022

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