Healthcare Provider Details

I. General information

NPI: 1992513378
Provider Name (Legal Business Name): JESSICA F PUCHALSKI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SAINT GEORGES AVE STE F
AVENEL NJ
07001-1000
US

IV. Provider business mailing address

4 BALDWIN CT
CRANFORD NJ
07016-2903
US

V. Phone/Fax

Practice location:
  • Phone: 732-860-9003
  • Fax:
Mailing address:
  • Phone: 732-236-2583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR01037100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: